Provider Demographics
NPI:1033378567
Name:GREENLEE, MAX RUSSELL JR (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:RUSSELL
Last Name:GREENLEE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1724
Mailing Address - Country:US
Mailing Address - Phone:303-442-3425
Mailing Address - Fax:303-442-3425
Practice Address - Street 1:870 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1724
Practice Address - Country:US
Practice Address - Phone:303-442-3425
Practice Address - Fax:303-442-3425
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12715207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology