Provider Demographics
NPI:1326085960
Name:GREAVES, RODNEY A (DO)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:A
Last Name:GREAVES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W CAMINO BUENA VIS
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-8904
Mailing Address - Country:US
Mailing Address - Phone:214-315-7664
Mailing Address - Fax:
Practice Address - Street 1:220 W CAMINO BUENA VIS
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-8904
Practice Address - Country:US
Practice Address - Phone:214-315-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13113207P00000X
TXH8661207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133013610Medicaid
D27411Medicare UPIN