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General NPI Number Information
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NPI Number | 1710081468
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Entity Type | Organization
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Legal Business Name | PHILLIP S. GREENE, M.D., INC.
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1418 BRICE RD
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-2397
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Country | US
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Telephone | 614-868-5131
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Fax |
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Provider Business Mailing Address
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Address Line | 1418 BRICE RD
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-2397
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Country | US
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Telephone | 614-868-5131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP S. GREENE
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Credential | M.D.
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Telephone | 614-868-5131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35-04-3686
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License Number State | OH
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