Provider Demographics
NPI:1992704498
Name:GREENSPAN, GARY HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:HOWARD
Last Name:GREENSPAN
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 1:601 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5848
Mailing Address - Country:US
Mailing Address - Phone:727-734-6191
Mailing Address - Fax:727-734-6715
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5848
Practice Address - Country:US
Practice Address - Phone:727-734-6191
Practice Address - Fax:727-734-6715
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32092207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065695000Medicaid
FL62312WMedicare ID - Type Unspecified
FL065695000Medicaid