Healthcare Provider Details

I. General information

NPI: 1497722771
Provider Name (Legal Business Name): TERRY KEITH GREBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 E 15TH ST
JOPLIN MO
64804-1201
US

IV. Provider business mailing address

2736 E 15TH ST
JOPLIN MO
64804-1201
US

V. Phone/Fax

Practice location:
  • Phone: 417-782-0166
  • Fax: 417-782-0166
Mailing address:
  • Phone: 417-782-0166
  • Fax: 417-782-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number34582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: