Provider Demographics
NPI:1457520868
Name:ROBERT W GREENE JR MD PC
Entity Type:Organization
Organization Name:ROBERT W GREENE JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-722-5833
Mailing Address - Street 1:220 S CLAYBROOK ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3527
Mailing Address - Country:US
Mailing Address - Phone:901-722-5833
Mailing Address - Fax:901-722-5837
Practice Address - Street 1:220 S CLAYBROOK ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3527
Practice Address - Country:US
Practice Address - Phone:901-722-5833
Practice Address - Fax:901-722-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD019597208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3047082Medicaid
TN3047082Medicaid