Healthcare Provider Details

I. General information

NPI: 1801079173
Provider Name (Legal Business Name): ROBERT G. MCGREEVY MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 N 10TH AVE
STAYTON OR
97383-2037
US

IV. Provider business mailing address

1371 N 10TH AVE
STAYTON OR
97383-2037
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-3785
  • Fax: 503-769-3741
Mailing address:
  • Phone: 503-769-3785
  • Fax: 503-769-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD17836
License Number StateOR

VIII. Authorized Official

Name: DR. ROBERT G MCGREEVY
Title or Position: OWNER
Credential: MD
Phone: 503-769-3785