Healthcare Provider Details

I. General information

NPI: 1386667962
Provider Name (Legal Business Name): JEFFREY R GRECO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W PARKER RD
PLANO TX
75093-8185
US

IV. Provider business mailing address

6200 W PARKER RD
PLANO TX
75093-8185
US

V. Phone/Fax

Practice location:
  • Phone: 972-293-5151
  • Fax: 972-981-3967
Mailing address:
  • Phone: 972-293-5151
  • Fax: 972-981-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM2626
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: