Provider Demographics
NPI:1063453520
Name:GREENE, JOHN F III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:GREENE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:236 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1348
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-274-4459
Practice Address - Street 1:225 HOSPITAL DRIVE
Practice Address - Street 2:BLDG B, STE 255
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391
Practice Address - Country:US
Practice Address - Phone:859-744-2623
Practice Address - Fax:859-744-9421
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY34919207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64349194Medicaid
KY000000290315OtherANTHEM
KY64349194Medicaid
KYG97200Medicare UPIN