Provider Demographics
NPI:1588716914
Name:GREENFIELD, DWYNN N (DO)
Entity type:Individual
Prefix:DR
First Name:DWYNN
Middle Name:N
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 DOCTORS ST
Mailing Address - Street 2:233 DOCTORS STREET
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-9247
Mailing Address - Country:US
Mailing Address - Phone:336-372-5511
Mailing Address - Fax:
Practice Address - Street 1:233 DOCTORS ST
Practice Address - Street 2:233 DOCTORS STREET
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-9247
Practice Address - Country:US
Practice Address - Phone:336-372-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201200080208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA16630Medicare UPIN