Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2012017805 | MO |
N | 111NI0900X | Internist | 2012017805 | MO |
Y | 207RH0000X | Hematologist | 52275 | SC |
NPI | 1043573009 |
---|---|
Provider Name | Dr. Irl Brian Greenwell |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2012 |
Last Update Date | 25/07/2018 |