Provider Demographics
NPI:1255666772
Name:GREENLEE, RALPH GILLESPIE JR (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:GILLESPIE
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 1:110 N MILAM ST # 120
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-3823
Mailing Address - Country:US
Mailing Address - Phone:830-864-5227
Mailing Address - Fax:
Practice Address - Street 1:213 W CREEK ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-3732
Practice Address - Country:US
Practice Address - Phone:214-695-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD57452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039258101Medicaid
TXC16279Medicare UPIN