Healthcare Provider Details

I. General information

NPI: 1619990355
Provider Name (Legal Business Name): JAMES ROBERT GREENBARG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E OLIVE AVE
TURLOCK CA
95380-4015
US

IV. Provider business mailing address

220 STANDIFORD AVE STE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 209-661-4403
  • Fax: 209-632-6662
Mailing address:
  • Phone: 209-579-5628
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG80805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: