Provider Demographics
NPI:1528017910
Name:GREANEY, RICHARD BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRIAN
Last Name:GREANEY
Suffix:
Gender:M
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:PO BOX 6428
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6428
Mailing Address - Country:US
Mailing Address - Phone:707-445-5431
Mailing Address - Fax:707-445-3710
Practice Address - Street 1:2330 BUHNE ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-442-3704
Practice Address - Fax:707-442-8986
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG417112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300050057OtherRR MEDICARE
CA00G417110Medicaid
CA00G417110Medicare ID - Type Unspecified
CA00G417110Medicaid
300050057OtherRR MEDICARE
A48664Medicare UPIN
00G417113Medicare PIN