Provider Demographics
NPI:1093749657
Name:GREENLEE, JOHN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3663 VIEWCREST CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3926
Mailing Address - Country:US
Mailing Address - Phone:801-585-2915
Mailing Address - Fax:801-581-4192
Practice Address - Street 1:CLINICAL NEUROSCIENCE CTR FL 5
Practice Address - Street 2:175 N MEDICAL DRIVE E.
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-5901
Practice Address - Country:US
Practice Address - Phone:801-585-2915
Practice Address - Fax:801-581-4192
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT17512312052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC49358Medicare UPIN