Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC002317-L | PA |
NPI | 1083642219 |
---|---|
Provider Name | Bruce G Greenfield |
First Address | Havertown, PA 19083-5215 |
Second Address | Havertown, PA 19083-5215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 10/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008501870001 | (05) | PA |
0816700001 | DME (01) | PA |
T27192 | (02) | PA |