Provider Demographics
NPI:1821669318
Name:GREER, DANIEL (IDC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GREER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BRACKISH PL
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3220
Mailing Address - Country:US
Mailing Address - Phone:409-998-6995
Mailing Address - Fax:
Practice Address - Street 1:5502 MARVIN SHIELDS BLVD
Practice Address - Street 2:BLDG 472
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-7000
Practice Address - Country:US
Practice Address - Phone:282-822-5509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
18216693181710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program