Provider Demographics
NPI:1912040940
Name:GREENFIELD, LAWRENCE STUART (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:STUART
Last Name:GREENFIELD
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 1:604 BALIBAY RD
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3323
Mailing Address - Country:US
Mailing Address - Phone:813-649-0407
Mailing Address - Fax:813-649-0646
Practice Address - Street 1:604 BALIBAY RD
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3323
Practice Address - Country:US
Practice Address - Phone:813-649-0407
Practice Address - Fax:813-649-0646
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95989207R00000X, 207RA0401X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA97837Medicaid
PAC29838Medicare UPIN
PAMA97837Medicaid