Provider Demographics
NPI:1982604088
Name:GREENSPOON, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GREENSPOON
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:PO BOX 410099
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-0099
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:815-346-3305
Practice Address - Street 1:6865 S TROPICAL TRL
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-6512
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:815-346-3305
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0036832207X00000X
FLME49803207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02666WOtherMEDICARE
FLMI442OtherMEDICARE
02666YMedicare UPIN
FL046088500Medicaid