Provider Demographics
NPI:1457819930
Name:GREENE, BRYAN J
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:J
Last Name:GREENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 NE MONROE LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6507
Mailing Address - Country:US
Mailing Address - Phone:253-350-4533
Mailing Address - Fax:
Practice Address - Street 1:1884 NE MONROE LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6507
Practice Address - Country:US
Practice Address - Phone:253-350-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program