Provider Demographics
NPI:1184861478
Name:CAL W GREENLAW MD PC
Entity Type:Organization
Organization Name:CAL W GREENLAW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREENLAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-646-4345
Mailing Address - Street 1:103 11TH ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1676
Mailing Address - Country:US
Mailing Address - Phone:660-646-4345
Mailing Address - Fax:660-646-6024
Practice Address - Street 1:103 11TH ST
Practice Address - Street 2:SUITE 16
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1676
Practice Address - Country:US
Practice Address - Phone:660-646-4345
Practice Address - Fax:660-646-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3F02207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty