Provider Demographics
NPI:1902359946
Name:GREENE, ROGERS JOSEPH JR
Entity Type:Individual
Prefix:MR
First Name:ROGERS
Middle Name:JOSEPH
Last Name:GREENE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 63RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-3300
Mailing Address - Country:US
Mailing Address - Phone:206-423-4654
Mailing Address - Fax:
Practice Address - Street 1:2215 63RD AVE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-3300
Practice Address - Country:US
Practice Address - Phone:206-423-4654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other