Healthcare Provider Details

I. General information

NPI: 1720085533
Provider Name (Legal Business Name): MARY CAROL GREENLEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BOOKCLIFF AVE STE 3
GRAND JUNCTION CO
81501-8162
US

IV. Provider business mailing address

1212 BOOKCLIFF AVE STE 3
GRAND JUNCTION CO
81501-8162
US

V. Phone/Fax

Practice location:
  • Phone: 970-254-1686
  • Fax: 970-254-1687
Mailing address:
  • Phone: 970-263-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number46947
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: