Provider Demographics
NPI:1629050059
Name:GREENE, BRIAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:GREENE
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 5430
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36205-0430
Mailing Address - Country:US
Mailing Address - Phone:256-237-1624
Mailing Address - Fax:256-241-2277
Practice Address - Street 1:171 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36205-4101
Practice Address - Country:US
Practice Address - Phone:256-237-1624
Practice Address - Fax:256-241-2277
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBG086607208C00000X
AL30509208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1430029OtherPHP
MI4770665Medicaid
AL30509OtherALABAMA LICENSE NUMBER
I41386Medicare UPIN
MI4770665Medicaid