Healthcare Provider Details

I. General information

NPI: 1477665867
Provider Name (Legal Business Name): DENISE E. GREENE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 SCENIC DR GERALD CHAMPION REGIONAL MEDICAL CENTER
ALAMOGORDO NM
88310-8700
US

IV. Provider business mailing address

2669 SCENIC DR GERALD CHAMPION REGIONAL MEDICAL CENTER
ALAMOGORDO NM
88310-8700
US

V. Phone/Fax

Practice location:
  • Phone: 575-446-5300
  • Fax: 575-446-5304
Mailing address:
  • Phone: 575-446-5300
  • Fax: 575-446-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA70569
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA70569
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA70569
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD2010-0804
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD2010-0804
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2010-0804
License Number StateNM
# 7
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46034
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: