Provider Demographics
NPI:1902856701
Name:GREENE, JUDY L (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 W ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2530
Mailing Address - Country:US
Mailing Address - Phone:623-931-7999
Mailing Address - Fax:623-842-5640
Practice Address - Street 1:2323 W ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2530
Practice Address - Country:US
Practice Address - Phone:623-931-7999
Practice Address - Fax:623-842-5640
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ402452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ359643Medicaid
AZZ128181Medicare PIN
AZZ124388Medicare PIN
AZ359643Medicaid
C02986Medicare UPIN