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

Similar Providers

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





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
1 NPI 1922123835
2 Entity Type Code 1
3 Provider Last Name Legal Name GREENTREE
4 Provider First Name GORDON
5 Provider Middle Name ERIC
6 Provider Name Prefix Text MR.
7 Provider Credential Text PHYSICIAN ASSISTANT
8 Provider Other Last Name GREENTREE
9 Provider Other First Name GORDON
10 Provider Other Middle Name ERIC
11 Provider Other Credential Text PA-C
12 Provider Other Last Name Type Code 2
13 Provider First Line Business Practice Location Address 123 SOUTH MAIN STREET
14 Provider Business Practice Location Address City Name FREER
15 Provider Business Practice Location Address State Name TX
16 Provider Business Practice Location Address Postal Code 783571750
17 Provider Business Practice Location Address Country Code If outside U S US
18 Provider Business Practice Location Address Telephone Number 3613947311
19 Provider Business Practice Location Address Fax Number 3613947158
20 Provider Enumeration Date 3/20/2007
21 Last Update Date 7/8/2007
22 Provider Gender Code M
23 Healthcare Provider Taxonomy Code 1 363AM0700X
24 Provider License Number 1 TXPA00041
25 Provider License Number State Code 1 TX
26 Healthcare Provider Primary Taxonomy Switch 1 Y
27 Is Sole Proprietor Y

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This page was last updated on: 12/10/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.