Provider Demographics
NPI:1902060049
Name:JACOB GREUEL MD PC
Entity Type:Organization
Organization Name:JACOB GREUEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:V
Authorized Official - Last Name:GREUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-955-1030
Mailing Address - Street 1:1715 N BUNNER ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2229
Mailing Address - Country:US
Mailing Address - Phone:251-955-1030
Mailing Address - Fax:251-955-5048
Practice Address - Street 1:1715 N BUNNER ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2229
Practice Address - Country:US
Practice Address - Phone:251-955-1030
Practice Address - Fax:251-955-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27744207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1902060049Medicaid
AL1902060049Medicaid