Greeson, Samuel Douglas

Greeson, Samuel Douglas is an individual health care provider with primary practice located at 7333 W Jefferson Blvd , Fort Wayne IN 46804-6280. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Occupational Medicine. Allopathic & Osteopathic Physicians / Occupational Medicine is his primary health care specialty. Greeson, Samuel Douglas can be contacted via phone (260) 458-3830.

Contact Information

Primary practice address
7333 W Jefferson Blvd Fort Wayne IN 46804-6280
Phone: (260) 458-3830
Fax: (260) 458-3831
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 01028597A Indiana
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 01028597A Indiana
Allopathic & Osteopathic Physicians / Occupational Medicine 2083X0100X 01028597A Indiana

Profile Details

NPI number 1760565402
LBN Legal business name Greeson, Samuel Douglas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2006
Last updated Mar 28th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760565402 NPPES
Indiana Other 000000646442 ANTHEM PROVIDER NUMBER
Indiana MEDICAID 100085750 ANTHEM PROVIDER NUMBER

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