Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | C402070 | CA |
NPI | 1003823162 |
---|---|
Provider Name | David Lee Greene |
First Address | Bishop, CA 93514-2517 |
Second Address | Bishop, CA 93514-2517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002085966 | NEVADA MEDICAID (01) | NV |
00C402070 | (05) | NV |
A37331 | (02) |