Provider Demographics
NPI:1386758712
Name:GREELEY, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:GREELEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 W 3RD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-7040
Mailing Address - Country:US
Mailing Address - Phone:509-747-5165
Mailing Address - Fax:509-747-5133
Practice Address - Street 1:1520 W 3RD AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7040
Practice Address - Country:US
Practice Address - Phone:509-747-5165
Practice Address - Fax:509-747-5133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030536208M00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0186577OtherLABOR & INDUSTRIES
WA1108455Medicaid
WAGAB10815Medicare ID - Type Unspecified
WA0186577OtherLABOR & INDUSTRIES