Basic Information
| Provider Information | |||||||||
| NPI: | 1124278924 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STUART N GREENBERG MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 511715 | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339511715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412065200 | ||||||||
| FaxNumber: | 9412066418 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 E MARION AVE | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412065200 | ||||||||
| FaxNumber: | 9412066418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 09/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | GREENBERG | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9412065200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME93237 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000527700 | 05 | FL | MEDICAID |