Bradford Greene, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

322764-1206 Issued in UT

Practice address

500 Foothill Blvd
Salt Lake City, UT 84148-0001

Phone

(801) 582-1565

NPI assigned

Jul 7, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215388800000",
    "number": "1295998508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10479 DIMPLE DELL RD",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840926521",
            "telephone_number": "801-943-8966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 FOOTHILL BLVD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841480001",
            "telephone_number": "801-582-1565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENE",
        "first_name": "BRADFORD",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-07",
        "last_updated": "2008-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "322764-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Logan Greenberg
• Myles David Greenberg, M.D.
• Richard A Greenberg, MD
• Samantha Greenberg, MS, MPH
• Kimberlee Ann Greenburg
• Casey Brian Greene, PT, DPT
• Dayna Joy Greene, MSN, CPNP
• Elizabeth Greene
• Jesse Greene
• Tara Lynn Greene, CSW

• Surgical Physician Assistant in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Surgical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.