Healthcare Provider Details

I. General information

NPI: 1114069267
Provider Name (Legal Business Name): ROBERT A. GREENE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 EAST ST SUITE 201
REDDING CA
96001-0800
US

IV. Provider business mailing address

PO BOX 994032
REDDING CA
96099-4032
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-9052
  • Fax: 530-244-9053
Mailing address:
  • Phone: 530-241-0473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG76421
License Number StateCA

VIII. Authorized Official

Name: ROBERT A. GREENE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-244-9052