MEDICARE: DR. JOHN EDWARD GREENLEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	1751231205	UT

General Provider Information

NPI Number	:	1093749657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EDWARD GREENLEE M.D.

Provider Business Mailing Address
First Line	:	3663 VIEWCREST CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3926
Country	:	US
Telephone Number	:	801-585-2915
Fax Number	:	801-581-4192

Provider Business Practice Location Address
First Line	:	CLINICAL NEUROSCIENCE CTR FL 5
Second Line	:	175 N MEDICAL DRIVE E.
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-5901
Country	:	US
Telephone Number	:	801-585-2915
Fax Number	:	801-581-4192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/02/2021

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