Healthcare Provider Details

I. General information

NPI: 1699756759
Provider Name (Legal Business Name): GEORGE RUSHTON GREER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DR STE 700B
SANTA FE NM
87505-5470
US

IV. Provider business mailing address

1 CASA DEL ORO WAY
SANTA FE NM
87508-8290
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-0312
  • Fax:
Mailing address:
  • Phone: 505-982-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number81-213
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: