Provider Demographics
NPI:1699822304
Name:GREENE, ALAN RUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RUSTIN
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:PROF
Other - First Name:ALAN
Other - Middle Name:RUSTIN
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9000 CROW CANYON RD
Mailing Address - Street 2:STE S-220
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-1189
Mailing Address - Country:US
Mailing Address - Phone:925-964-9464
Mailing Address - Fax:
Practice Address - Street 1:730 WELCH RD
Practice Address - Street 2:PRIMARY CARE CLINIC, FIRST FLOOR
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1503
Practice Address - Country:US
Practice Address - Phone:925-964-1793
Practice Address - Fax:925-964-1794
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG063446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics