Individual
SAMUEL DOUGLAS GREESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7333 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6280
(260) 458-3830
(260) 458-3831
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3516
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01028597A
IN
208100000X
Physical Medicine & Rehabilitation Physician
01028597A
IN
2083X0100X
Occupational Medicine Physician
Primary
01028597A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000646442
ANTHEM PROVIDER NUMBER
IN
05
—
100085750
—
IN
Enumeration date
10/24/2006
Last updated
03/28/2022
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