Provider Demographics
NPI:1992761563
Name:GREENLEES, GENE (MD)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:
Last Name:GREENLEES
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 1:150 ALLEN LOOP DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-4146
Mailing Address - Country:US
Mailing Address - Phone:850-428-0814
Mailing Address - Fax:
Practice Address - Street 1:150 ALLEN LOOP DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-4146
Practice Address - Country:US
Practice Address - Phone:850-428-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0063207L00000X
FLME84188207L00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00723529OtherRAILROAD MEDICARE
TX8BZ581OtherBLUE CROSS BLUE SHIELD
FL263459700Medicaid
TX8BZ581OtherBLUE CROSS BLUE SHIELD
TXP00723529OtherRAILROAD MEDICARE