Healthcare Provider Details

I. General information

NPI: 1225320906
Provider Name (Legal Business Name): ERIC MCKENZIE GREBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date: 02/19/2018
Reactivation Date: 02/27/2018

III. Provider practice location address

726 N ACADIA RD STE 1000
THIBODAUX LA
70301-5009
US

IV. Provider business mailing address

PO BOX 28
THIBODAUX LA
70302-0028
US

V. Phone/Fax

Practice location:
  • Phone: 985-625-2200
  • Fax: 985-625-2206
Mailing address:
  • Phone: 985-625-2200
  • Fax: 985-625-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD.306703
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: