Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 113320 | MO |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 113320 | MO |
NPI | 1447252978 |
---|---|
Provider Name | Dr. Brett R Grebing |
First Address | Maryville, IL 62062 |
Second Address | Maryville, IL 62062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 16/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H72045 | (02) |