Provider Demographics
NPI:1194996884
Name:GREENE, RYAN MERRILL (MD, PHD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MERRILL
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3657
Mailing Address - Country:US
Mailing Address - Phone:954-651-6600
Mailing Address - Fax:954-651-6601
Practice Address - Street 1:2731 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3657
Practice Address - Country:US
Practice Address - Phone:954-651-6600
Practice Address - Fax:954-651-6601
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100650207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery