Provider Demographics
NPI:1659312627
Name:GREENE, HENRY REX (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:REX
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 1:710 S LINCOLN RD
Mailing Address - Street 2:STE 400
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1293
Mailing Address - Country:US
Mailing Address - Phone:906-233-9363
Mailing Address - Fax:906-789-3103
Practice Address - Street 1:2710 DOLBEER 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:707-267-2060
Practice Address - Fax:707-267-2061
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120037207RX0202X
OH35087628207RH0003X
CAG19771207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4042485OtherAETNA
FL019021800Medicaid
FLP01745576OtherRR MEDICARE
FL1336770OtherWELLCARE THRU KEYS PHA
OH2648139Medicaid
E02598Medicare UPIN
FLP01745576OtherRR MEDICARE
OH2648139Medicaid