Provider Demographics
NPI:1275509085
Name:GREENE, GARRY REID (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:REID
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:990 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2851
Mailing Address - Country:US
Mailing Address - Phone:360-479-3657
Mailing Address - Fax:360-373-7616
Practice Address - Street 1:990 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2851
Practice Address - Country:US
Practice Address - Phone:360-479-3657
Practice Address - Fax:360-373-7616
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00020694207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7215GAOtherREGENCE BLUE SHEILD
WA0204577OtherWA DEPT OF LABOR AND IND
WA8443798Medicaid
WA910847215OtherUNIFORM MEDICAL
WA016487001OtherGROUP HEALTH COOP
WA910847215OtherPREMERA BLUE CROSS
WA910847215OtherCHAMPUS
WA8443798Medicaid
WA016487001OtherGROUP HEALTH COOP