Provider Demographics
NPI:1073336327
Name:GREER, JARED JAMES
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:JAMES
Last Name:GREER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W 15TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5802
Mailing Address - Country:US
Mailing Address - Phone:214-691-9777
Mailing Address - Fax:214-691-1123
Practice Address - Street 1:4001 W 15TH ST STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5802
Practice Address - Country:US
Practice Address - Phone:214-691-9777
Practice Address - Fax:214-691-1123
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA18710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program