Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35066921 | OH |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35-066921 | OH |
NPI | 1073590394 |
---|---|
Provider Name | Dr. Richard L Greeno JR. |
First Address | Miamisburg, OH 45342-5354 |
Second Address | Centerville, OH 45459-1221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 27/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2530238 | (05) | OH |
4145201 | MEDICARE PTAN (01) | OH |
4145202 | MEDICARE PTAN (01) | OH |
H33541 | (02) | OH |