Healthcare Provider Details

I. General information

NPI: 1164593182
Provider Name (Legal Business Name): RONALD D GREENWOOD MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SUNRISE AVE SUITE N
ROSEVILLE CA
95661
US

IV. Provider business mailing address

700 SUNRISE AVE SUITE N
ROSEVILLE CA
95661
US

V. Phone/Fax

Practice location:
  • Phone: 916-782-6700
  • Fax: 916-782-6767
Mailing address:
  • Phone: 916-782-6700
  • Fax: 916-782-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG21173
License Number StateCA

VIII. Authorized Official

Name: DR. RONALD D GREENWOOD
Title or Position: PRESIDENT CORPORATION PEDIATRICIAN
Credential: MD
Phone: 916-782-6700