Provider Demographics
NPI:1669494720
Name:GREATHOUSE, CYNTHIA JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JOYCE
Last Name:GREATHOUSE
Suffix:
Gender:F
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 15759
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5759
Mailing Address - Country:US
Mailing Address - Phone:850-763-0260
Mailing Address - Fax:850-769-0892
Practice Address - Street 1:760 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4003
Practice Address - Country:US
Practice Address - Phone:850-763-0260
Practice Address - Fax:850-769-0892
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92315207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLO1586OtherBLUE CROSS BLUE SHIELD
FLP00184814OtherRAILROAD MEDICARE
FL271570800Medicaid
FLO1586OtherBLUE CROSS BLUE SHIELD
FL271570800Medicaid