Provider Demographics
NPI:1205947181
Name:GREENER, VICTOR L (DPM)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:GREENER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E ALMOND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5653
Mailing Address - Country:US
Mailing Address - Phone:559-674-3338
Mailing Address - Fax:559-674-1149
Practice Address - Street 1:300 E ALMOND AVE STE 105
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5653
Practice Address - Country:US
Practice Address - Phone:559-674-3338
Practice Address - Fax:559-674-1149
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3225213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E32250Medicaid
CA000E32250Medicaid
000E32250Medicare PIN