MR. GORDON ERIC GREENTREE, PHYSICIAN ASSISTANT - NPI NUMBER 1922123835

Summary

Provider Name: MR. GORDON ERIC GREENTREE, PHYSICIAN ASSISTANT

NPI Number: 1922123835

Clasification: Physician Assistant (363AM0700X)

Specialization: Medical

Address:
123 SOUTH MAIN STREET
FREER, TX
ZIP 78357

Phone Number: (361) 394-7311



Detailed Information

MR. Gordon Eric Greentree, PHYSICIAN ASSISTANT is a medical physician assistant in Freer, TX. The assigned NPI number for this provider is 1922123835 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

123 SOUTH MAIN STREET
FREER, TX
ZIP 78357-750
Phone: (361) 394-7311
Fax: (361) 394-7158

The enumeration date for this NPI number is 3/20/2007 and was last updated on 7/8/2007.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363AM0700X Physician Assistant Medical TXPA00041 TX Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1922123835 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name GREENTREE The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name GORDON The first name of the provider, if the provider is an individual.
5 Provider Middle Name ERIC The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text MR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text PHYSICIAN ASSISTANT The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider Other Last Name GREENTREE Other last name by which the provider being identified is or has been known.
9 Provider Other First Name GORDON Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only.
10 Provider Other Middle Name ERIC Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider is or has been known by a different last name only.
11 Provider Other Credential Text PA-C The other abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
12 Provider Other Last Name Type Code 2 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
13 Provider First Line Business Practice Location Address 123 SOUTH MAIN STREET The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
14 Provider Business Practice Location Address City Name FREER The city name in the location address of the provider being identified.
15 Provider Business Practice Location Address State Name TX The State code in the location of the provider being identified.
16 Provider Business Practice Location Address Postal Code 783571750 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
17 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
18 Provider Business Practice Location Address Telephone Number 3613947311 The telephone number associated with the location address of the provider being identified.
19 Provider Business Practice Location Address Fax Number 3613947158 The fax number associated with the location address of the provider being identified.
20 Provider Enumeration Date 3/20/2007 The date the provider was assigned a unique identifier (assigned an NPI).
21 Last Update Date 7/8/2007 The date that a record was last updated or changed.
22 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
23 Healthcare Provider Taxonomy Code 1 363AM0700X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
24 Provider License Number 1 TXPA00041 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
25 Provider License Number State Code 1 TX The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
26 Healthcare Provider Primary Taxonomy Switch 1 Y
27 Is Sole Proprietor Y Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

Similar Providers Nearby

NPI Provider Name NPI Type Taxonomy
1568465722 AMY WICKE, PA-C Individual Physician Assistant (Medical)


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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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