Provider Demographics
NPI:1265647226
Name:GREBNER, TODD RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:RICHARD
Last Name:GREBNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2415 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3322
Mailing Address - Country:US
Mailing Address - Phone:423-624-2696
Mailing Address - Fax:423-697-2055
Practice Address - Street 1:2415 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3322
Practice Address - Country:US
Practice Address - Phone:423-624-2696
Practice Address - Fax:423-697-2055
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDO2353207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDO2353OtherMEDICAL LICENSE
10320I9263Medicare PIN