Healthcare Provider Details

I. General information

NPI: 1063453520
Provider Name (Legal Business Name): JOHN F. GREENE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N EAGLE CREEK DR STE 104
LEXINGTON KY
40509-9087
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-967-5848
  • Fax: 859-967-5473
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-967-5473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34919
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: