Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | DC22353 | CA |
NPI | 1700072899 |
---|---|
Provider Name | Dr. William J. Greene |
First Address | Brea, CA 92821-3633 |
Second Address | Brea, CA 92821-4054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2007 |
Last Update Date | 21/09/2007 |