Healthcare Provider Details

I. General information

NPI: 1780973966
Provider Name (Legal Business Name): DEVON GREER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 08/16/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703-7440
US

IV. Provider business mailing address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703-7440
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-6028
  • Fax:
Mailing address:
  • Phone: 907-361-6028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number26926
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: