Provider Demographics
NPI:1306958095
Name:GREIF, JON MEREDITH (DO)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:MEREDITH
Last Name:GREIF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3117
Mailing Address - Country:US
Mailing Address - Phone:510-835-9900
Mailing Address - Fax:510-835-9909
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:SUITE 212
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-835-9900
Practice Address - Fax:510-835-9909
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4984208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A4984OtherMEDICAL LICENSE
AG1049394OtherDEA NUMBER