Provider Demographics
NPI:1215933452
Name:GREENE, RICHARD STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEPHEN
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:STE 501
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1857
Mailing Address - Country:US
Mailing Address - Phone:954-473-6750
Mailing Address - Fax:954-424-7093
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:STE 501
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1857
Practice Address - Country:US
Practice Address - Phone:954-473-6750
Practice Address - Fax:954-424-7093
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14457207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61428Medicare UPIN
06789VMedicare ID - Type Unspecified