Healthcare Provider Details

I. General information

NPI: 1588336481
Provider Name (Legal Business Name): ROBERT GREATHOUSE ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 N SCOTTSDALE RD STE 200
SCOTTSDALE AZ
85254-4058
US

IV. Provider business mailing address

21021 N 56TH ST APT 2021
PHOENIX AZ
85054-5571
US

V. Phone/Fax

Practice location:
  • Phone: 833-500-1753
  • Fax: 800-768-2175
Mailing address:
  • Phone: 585-297-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number21-1679
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: