Healthcare Provider Details

I. General information

NPI: 1265513352
Provider Name (Legal Business Name): JOHN HARRY GREBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER
GAINESVILLE FL
32610
US

IV. Provider business mailing address

8200 DODGE STREET
OMAHA NE
68114
US

V. Phone/Fax

Practice location:
  • Phone: 352-338-2121
  • Fax:
Mailing address:
  • Phone: 402-955-6140
  • Fax: 402-955-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN 7898
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25664
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: