Healthcare Provider Details

I. General information

NPI: 1659312627
Provider Name (Legal Business Name): HENRY REX GREENE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 DOLBEER ST
EUREKA CA
95501
US

IV. Provider business mailing address

710 S LINCOLN RD STE 400
ESCANABA MI
49829-1293
US

V. Phone/Fax

Practice location:
  • Phone: 707-267-2060
  • Fax: 707-267-2061
Mailing address:
  • Phone: 906-233-9363
  • Fax: 906-789-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME120037
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35087628
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG19771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: