Provider Demographics
NPI:1699750570
Name:GREER, JEROLD STEPHEN (LSA)
Entity type:Individual
Prefix:MR
First Name:JEROLD
Middle Name:STEPHEN
Last Name:GREER
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MONKEY RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-5506
Mailing Address - Country:US
Mailing Address - Phone:432-935-1755
Mailing Address - Fax:512-285-4776
Practice Address - Street 1:236 MONKEY RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-5506
Practice Address - Country:US
Practice Address - Phone:432-935-1755
Practice Address - Fax:512-285-4776
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00074246ZC0007X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA0074Medicare UPIN