Provider Demographics
NPI:1730318403
Name:GREESON, CLAY BRYSON (MD)
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:BRYSON
Last Name:GREESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 11TH CT STE 302
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5012
Mailing Address - Country:US
Mailing Address - Phone:772-794-1444
Mailing Address - Fax:
Practice Address - Street 1:3450 11TH CT STE 302
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5012
Practice Address - Country:US
Practice Address - Phone:772-794-1444
Practice Address - Fax:772-794-1475
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143112207X00000X
KS04-38240207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107436900Medicaid
KSKA1610073Medicare PIN