Healthcare Provider Details

I. General information

NPI: 1629476825
Provider Name (Legal Business Name): BRYAN JAMES GREENAWAY AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date: 08/26/2019
Reactivation Date: 09/05/2019

III. Provider practice location address

7445 SE 282ND AVE
GRESHAM OR
97080-8218
US

IV. Provider business mailing address

4207 SE WOODSTOCK BLVD STE 202
PORTLAND OR
97206-6267
US

V. Phone/Fax

Practice location:
  • Phone: 503-395-0182
  • Fax: 971-356-0899
Mailing address:
  • Phone: 503-395-0182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number30954
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number030954
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: