Healthcare Provider Details

I. General information

NPI: 1255411369
Provider Name (Legal Business Name): JEFFREY P GREEP HS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US COAST GUARD SECTOR SOUTH BROAD ST
MOBILE AL
36615
US

IV. Provider business mailing address

13431 TOM GASTON RD
MOBILE AL
36695-8663
US

V. Phone/Fax

Practice location:
  • Phone: 251-441-6340
  • Fax: 251-441-5498
Mailing address:
  • Phone: 251-441-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: