Provider Demographics
NPI:1669415253
Name:GREENFIELD, DAVID IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IVAN
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1525 TAMIAMI TRL S
Mailing Address - Street 2:SUITE 601
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3568
Mailing Address - Country:US
Mailing Address - Phone:941-497-4069
Mailing Address - Fax:941-496-9145
Practice Address - Street 1:1525 TAMIAMI TRL S
Practice Address - Street 2:SUITE 601
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3568
Practice Address - Country:US
Practice Address - Phone:941-497-4069
Practice Address - Fax:941-496-9145
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46436207R00000X
FLME0046436207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048713900Medicaid
FL592574814OtherTIN/OTHER INSURANCE
FL048713900Medicaid
FL048713900Medicaid