Provider Demographics
NPI:1902805724
Name:GREENFIELD, BRUCE MYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MYRON
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2024 SOUTH SIXTH STREET
Mailing Address - Street 2:BRAINERD MEDICAL CENTER
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401
Mailing Address - Country:US
Mailing Address - Phone:218-828-2880
Mailing Address - Fax:218-828-7107
Practice Address - Street 1:2024 SOUTH SIXTH STREET
Practice Address - Street 2:BRAINERD MEDICAL CENTER
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401
Practice Address - Country:US
Practice Address - Phone:218-828-2880
Practice Address - Fax:218-828-7107
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-10-05
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Provider Licenses
StateLicense IDTaxonomies
NM73-125207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C97800Medicare UPIN