Provider Demographics
NPI:1437379559
Name:GREENE, DEBORAH REYNOLDS (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:REYNOLDS
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5266
Mailing Address - Country:US
Mailing Address - Phone:510-569-9334
Mailing Address - Fax:510-569-9309
Practice Address - Street 1:10850 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5266
Practice Address - Country:US
Practice Address - Phone:510-569-9334
Practice Address - Fax:510-569-9309
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA564462083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine