Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2008016701 | MO |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2011005769 | MO |
NPI | 1326200692 |
---|---|
Provider Name | Nicholas Austin Greiner |
First Address | Hazelwood, MO 63042-1754 |
Second Address | Hazelwood, MO 63042-1754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 29/09/2014 |