Provider Demographics
NPI:1831541333
Name:GREAVES, ERNEST
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:GREAVES
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 1:1639 NW ESTELLE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1610
Mailing Address - Country:US
Mailing Address - Phone:541-378-2488
Mailing Address - Fax:
Practice Address - Street 1:1639 NW ESTELLE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1610
Practice Address - Country:US
Practice Address - Phone:541-378-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3837189347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle