Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME100650 | FL |
NPI | 1194996884 |
---|---|
Provider Name | Ryan Merrill Greene |
First Address | Weston, FL 33331-3657 |
Second Address | Weston, FL 33331-3657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2008 |
Last Update Date | 13/11/2013 |