Provider Demographics
NPI:1710086384
Name:GREENE, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15466 LOS GATOS BLVD. ST 109-206
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-871-1418
Mailing Address - Fax:408-871-1419
Practice Address - Street 1:634 N SANTA CRUZ AVE, ST 210
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030
Practice Address - Country:US
Practice Address - Phone:408-871-1418
Practice Address - Fax:408-354-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA694312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A694310Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER