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NPI Code Detail

MEDICARE: JAMES WILLIAM GREENAWALT III M.D.

MEDICARE: JAMES WILLIAM GREENAWALT III M.D.
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
1207L00000XAnesthesiology Physician14759OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750385175
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES WILLIAM GREENAWALT III M.D.
Provider Business Mailing Address
First Line : 6839 S CANTON AVE
Second Line :
City : TULSA
State : OK
Zip : 74136-3402
Country : US
Telephone Number : 918-494-0612
Fax Number :
Provider Business Practice Location Address
First Line : 6161 S YALE AVE
Second Line :
City : TULSA
State : OK
Zip : 74136-1902
Country : US
Telephone Number : 918-494-0612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 04/29/2022

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