Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 20639 | KY |
N | 111NI0900X | Internist | 20639 | KY |
Y | 207RG0300X | Geriatric Medicine | C148038 | CA |
NPI | 1104802594 |
---|---|
Provider Name | David A Greene |
First Address | Santa Rosa, CA 95403-3634 |
Second Address | Santa Rosa, CA 95409-8846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 22/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64206394 | (05) | KY |
B88011 | (02) | KY |