Provider Demographics
NPI:1356650675
Name:RICHARD C. GREYSON, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD C. GREYSON, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:GREYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-232-2702
Mailing Address - Street 1:1110 N CLASSEN BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6842
Mailing Address - Country:US
Mailing Address - Phone:405-232-2702
Mailing Address - Fax:405-272-0839
Practice Address - Street 1:1110 N CLASSEN BLVD STE 301
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6842
Practice Address - Country:US
Practice Address - Phone:405-232-2702
Practice Address - Fax:405-272-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100111660AMedicaid
OK100111660AMedicaid