Provider Demographics
NPI:1710062542
Name:GREER, HILTON THOMAS JR
Entity Type:Individual
Prefix:
First Name:HILTON
Middle Name:THOMAS
Last Name:GREER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:H
Other - Middle Name:THOMAS
Other - Last Name:GREER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4245 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6008
Practice Address - Country:US
Practice Address - Phone:206-598-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1856OtherINTERNAL ID-MOTOR VEHICLE ID
WA8295404Medicaid
A04599Medicare UPIN
WA000101954Medicare PIN