Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | ME27693 | FL |
NPI | 1316038615 |
---|---|
Provider Name | Dr. Jack Leeland Greider JR. |
First Address | Jacksonville, FL 32216-4368 |
Second Address | Jacksonville, FL 32216-4368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 25/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37943300 | (05) | FL |
D65831 | (02) | FL |