Provider Demographics
NPI:1427084136
Name:GREATHOUSE, ALETA B (MD)
Entity type:Individual
Prefix:
First Name:ALETA
Middle Name:B
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-347-8310
Mailing Address - Fax:417-347-8314
Practice Address - Street 1:932 E 34TH STREET
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-347-8310
Practice Address - Fax:417-347-8314
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KSTW00066207RN0300X
MO119577207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200045630AMedicaid
MO204693410Medicaid
KS100346130EMedicaid
121157OtherANTHEM
P00175279OtherRR MEDICARE