Organization Name: | GARY L. GREENLY, D.O., INC |
NPI Number: | 1871830794 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GARY L. GREENLY (PHYSICIAN) |
Mailing Address: | 549 Halemaumau St C-1 Honolulu |
State: | HI US |
Postal Code: | 968212150 |
Phone Number: | 8083732167 |
Fax Number: | 8083733330 |
NPI Enumeration Date: | 01/11/2013 |
NPI Last Update Date: | 01/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 525 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |