=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326496746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL DAVID GREENE II M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2016
-----------------------------------------------------
Last Update Date | 05/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 E ROMIE LN
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-4029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-759-1840
-----------------------------------------------------
Fax | 831-753-6286
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 E ROMIE LN
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-4029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-759-1840
-----------------------------------------------------
Fax | 831-753-6286
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | A162342
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------