Individual
DR. BRADLEY NOEL GREENHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
516 PEGRAM DR, TUPELO, MS 38801-6347
(662) 844-6272
(662) 844-1603
Mailing address
516 PEGRAM DR, TUPELO, MS 38801-6347
(662) 844-6272
(662) 844-1603
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
23810
MS
207ND0101X
MOHS-Micrographic Surgery Physician
23810
MS
207NS0135X
Procedural Dermatology Physician
23810
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T-2318
TEMPORART MS MEDICAL LICENSE NUMBER
MS
Enumeration date
07/08/2010
Last updated
05/19/2015
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