Provider Demographics
NPI:1417920927
Name:GRECO, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:GRECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE A226
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-432-5555
Mailing Address - Fax:314-432-1415
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE A226
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-432-5555
Practice Address - Fax:314-432-1415
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2010-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR6B71207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10323Medicare UPIN