Provider Demographics
NPI:1639219108
Name:GREENWAY, ROY MACK JR (MD, FACS)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:MACK
Last Name:GREENWAY
Suffix:JR
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:ROY
Other - Middle Name:M
Other - Last Name:GREENWAY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2339
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-2339
Mailing Address - Country:US
Mailing Address - Phone:580-225-2517
Mailing Address - Fax:580-225-3167
Practice Address - Street 1:401 SW 80TH ST STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8123
Practice Address - Country:US
Practice Address - Phone:405-601-5169
Practice Address - Fax:405-601-9095
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23986207X00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200196600AMedicaid
OK200196600AMedicaid
OKOK403593Medicare PIN