Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125061364 | IL |
N | 111NI0900X | Internist | 125061364 | IL |
NPI | 1003170861 |
---|---|
Provider Name | Dr. Stephen John Greene |
First Address | Durham, NC 27705-4699 |
Second Address | Durham, NC 27705-4699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 26/10/2015 |