Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | A135081 | CA |
Y | 207WX0107X | Retina Specialist | 4301502124 | MI |
NPI | 1114366440 |
---|---|
Provider Name | Greg Bever |
First Address | Grand Rapids, MI 49546-3725 |
Second Address | Grand Rapids, MI 49546-3725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 09/02/2021 |