Healthcare Provider Details

I. General information

NPI: 1164879102
Provider Name (Legal Business Name): JACOB GREER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 COUNTY ROAD HQ SUITE 5
MARQUETTE MI
49855-8855
US

IV. Provider business mailing address

1802 GALLOWAY ST
EAU CLAIRE WI
54703-3467
US

V. Phone/Fax

Practice location:
  • Phone: 906-228-3577
  • Fax:
Mailing address:
  • Phone: 715-831-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501008980
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: