Healthcare Provider Details

I. General information

NPI: 1558361329
Provider Name (Legal Business Name): STEPHEN GREER DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N LUDLOW ST SUITE 1125
DAYTON OH
45402-1116
US

IV. Provider business mailing address

131 N LUDLOW ST SUITE 1125
DAYTON OH
45402-1116
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-2911
  • Fax: 937-461-5102
Mailing address:
  • Phone: 937-223-2911
  • Fax: 937-461-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number34-00-3010
License Number StateOH

VIII. Authorized Official

Name: STEPHEN GREER
Title or Position: PRESIDENT/SURGEON
Credential: DO
Phone: 937-223-2911