Provider Demographics
NPI:1134537913
Name:GREIG, MARK ABRAHAM (OMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ABRAHAM
Last Name:GREIG
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 RANGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2125
Mailing Address - Country:US
Mailing Address - Phone:727-223-8911
Mailing Address - Fax:727-223-8917
Practice Address - Street 1:2120 RANGE RD STE 2
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2125
Practice Address - Country:US
Practice Address - Phone:727-223-8911
Practice Address - Fax:727-223-8917
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2097171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist