Individual
GRETA JEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
3057 SPRINGDALE AVE, SPRINGDALE, AR 72762-4346
(479) 756-1699
(479) 756-1693
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
(870) 347-1235
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-9524
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
217423001
—
AR
Enumeration date
06/24/2013
Last updated
10/06/2021
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