MEDICARE: MR. JEROLD STEPHEN GREER LSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	SA00074	TX

General Provider Information

NPI Number	:	1699750570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEROLD STEPHEN GREER LSA

Provider Business Mailing Address
First Line	:	236 MONKEY RD
Second Line	:
City	:	ELGIN
State	:	TX
Zip	:	78621-5506
Country	:	US
Telephone Number	:	432-935-1755
Fax Number	:	512-285-4776

Provider Business Practice Location Address
First Line	:	236 MONKEY RD
Second Line	:
City	:	ELGIN
State	:	TX
Zip	:	78621-5506
Country	:	US
Telephone Number	:	432-935-1755
Fax Number	:	512-285-4776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	10/08/2015

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