Jesse S. Greenblum, MD, PA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

ME45241 Issued in FL

Legal business name

JESSE S. GREENBLUM, MD, PA

Practice address

1411 S 14TH St
Suite B
Fernandina Beach, FL 32034-3031

Phone

(904) 261-5605

Fax

(904) 277-0725

NPI assigned

Jan 22, 2015

Last updated

Jan 22, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jesse Greenblum, M.D.

Title

Physician

Phone

(904) 261-5605

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421884800000",
    "number": "1447649835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 S 14TH ST",
            "address_2": "SUITE B",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320343031",
            "telephone_number": "904-261-5605",
            "fax_number": "904-277-0725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 S 14TH ST",
            "address_2": "SUITE B",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320343031",
            "telephone_number": "904-261-5605",
            "fax_number": "904-277-0725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSE S. GREENBLUM, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2015-01-22",
        "status": "A",
        "authorized_official_last_name": "GREENBLUM",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "904-261-5605",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME45241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.