Provider Demographics
NPI:1700332830
Name:GREENWOOD, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GREENWOOD
Suffix:
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 1:22093 GOLDEN ELM CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4217
Mailing Address - Country:US
Mailing Address - Phone:140-524-9155
Mailing Address - Fax:
Practice Address - Street 1:3667 N LOTTIE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-4517
Practice Address - Country:US
Practice Address - Phone:405-605-6080
Practice Address - Fax:405-605-6076
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker