Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 010430 | ME |
NPI | 1023013257 |
---|---|
Provider Name | Dr. David T. Greenleaf |
First Address | Portland, ME 04102-2102 |
Second Address | Portland, ME 04102-2102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B86765 | (02) |