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NPI Code Detail

MEDICARE: JERRY GREENBERG MD PC

MEDICARE: JERRY GREENBERG MD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician

General Provider Information

NPI Number : 1205428976
Entity Type Code : Organization
Provider Name (Legal Business Name) : JERRY GREENBERG MD PC
Provider Business Mailing Address
First Line : 6825 N COLUMBUS BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85718-2511
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6369 E TANQUE VERDE RD STE 160
Second Line :
City : TUCSON
State : AZ
Zip : 85715-3833
Country : US
Telephone Number : 520-403-7727
Fax Number :
Authorized Official
Title or Position : OWNER/PROVIDER
Name : JERRY GREENBERG
Credential : MD
Telephone Number : 520-403-7727
Provider Enumeration Date : 02/04/2021
Last Update Date : 03/15/2021

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