=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780677047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL E GREENAN DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2005
-----------------------------------------------------
Last Update Date | 05/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17820 1ST AVE S SUITE 101
-----------------------------------------------------
City | BURIEN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98148-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-248-3668
-----------------------------------------------------
Fax | 206-244-2499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17820 1ST AVE S SUITE 101
-----------------------------------------------------
City | BURIEN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98148-1794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-592-5000
-----------------------------------------------------
Fax | 206-824-9510
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO00000701
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO00000701
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------