Provider Demographics
NPI:1871685925
Name:GREENLEE, SAMUEL R II (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
Last Name:GREENLEE
Suffix:II
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 1:1500 N PACE BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-6467
Mailing Address - Country:US
Mailing Address - Phone:850-435-8998
Mailing Address - Fax:850-435-8995
Practice Address - Street 1:1500 N PACE BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-6467
Practice Address - Country:US
Practice Address - Phone:850-435-8998
Practice Address - Fax:850-435-8995
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE62761Medicare UPIN
FLK1710Medicare ID - Type UnspecifiedGROUP MEDICARE PROV #
FL11483YMedicare ID - Type UnspecifiedIND. MEDICARE PROV #