Provider Demographics
NPI:1821094483
Name:GREENLEE, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 SWAINSONS RUN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-8521
Mailing Address - Country:US
Mailing Address - Phone:230-262-6890
Mailing Address - Fax:239-262-2147
Practice Address - Street 1:2031 SWAINSONS RUN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-8521
Practice Address - Country:US
Practice Address - Phone:230-262-6890
Practice Address - Fax:239-262-2147
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0015096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC24667Medicare UPIN