# JESSE S. GREENBLUM, MD, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447649835
- **Authorized official:** JESSE GREENBLUM M.D. (PHYSICIAN)
- **Authorized official phone:** (904) 261-5605

## Contact information

- **Practice address:** 1411 S 14TH ST, SUITE B, FERNANDINA BEACH, FL 32034-3031
- **Practice address phone:** (904) 261-5605
- **Practice address fax:** (904) 277-0725
- **Mailing address:** 1411 S 14TH ST, SUITE B, FERNANDINA BEACH, FL 32034-3031
- **Mailing address phone:** (904) 261-5605
- **Mailing address fax:** (904) 277-0725

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | ME45241 | FL | Yes |

## Other

- **Enumeration date:** 01/22/2015
- **Last updated:** 01/22/2015