Provider Demographics
NPI:1467655647
Name:GREENLEE, JUSTIN STUART (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:STUART
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:90 CIC BLVD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-8024
Practice Address - Country:US
Practice Address - Phone:937-544-8989
Practice Address - Fax:937-544-5659
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2020-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34008782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2761382Medicaid
KY7100020960Medicaid