MEDICARE: DR. LAURIE MARSHALL GREENBERG MD

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
1	207Q00000X	Family Medicine Physician	F9497	TX

General Provider Information

NPI Number	:	1548421951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE MARSHALL GREENBERG MD

Provider Business Mailing Address
First Line	:	12672 SILICON DR
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3449
Country	:	US
Telephone Number	:	210-625-9690
Fax Number	:

Provider Business Practice Location Address
First Line	:	12672 SILICON DRIVE
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3449
Country	:	US
Telephone Number	:	210-625-9690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	06/18/2008

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