Provider Demographics
NPI:1295739811
Name:GREENE, TREVOR O (MD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:O
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3550 UNIVERSITY BLVD S
Mailing Address - Street 2:STE 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4226
Mailing Address - Country:US
Mailing Address - Phone:904-733-4444
Mailing Address - Fax:904-733-5377
Practice Address - Street 1:3550 UNIVERSITY BLVD S
Practice Address - Street 2:STE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4226
Practice Address - Country:US
Practice Address - Phone:904-733-4444
Practice Address - Fax:904-733-5377
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 89472207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268976600Medicaid
FLP00060522OtherRAILROAD MEDICARE
FL37706OtherBCBS
FLE62108Medicare UPIN
FL37706OtherBCBS
FL37706ZMedicare PIN
FL37706YMedicare PIN