MEDICARE: GARY M GREENBERG M.D.

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	207R00000X	Internal Medicine Physician	MD14811	OR
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	MD14811	OR
3	207RC0000X	Cardiovascular Disease Physician	MD14811	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720070683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY M GREENBERG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3397
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3397
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 S WAHANNA RD STE 230
Second Line	:
City	:	SEASIDE
State	:	OR
Zip	:	97138-7735
Country	:	US
Telephone Number	:	503-717-7850
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/02/2021

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