Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 904 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 8335 | KY |
NPI | 1164527420 |
---|---|
Provider Name | Dr. Tony Brandon Greer |
First Address | Bowling Green, KY 42104-3326 |
Second Address | Bowling Green, KY 42104-3326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 02/06/2014 |