=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093994998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROY A GREENBERG MD A PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2007
-----------------------------------------------------
Last Update Date | 11/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 CREEKSIDE DR SUITE 2100
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-3444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-983-2663
-----------------------------------------------------
Fax | 916-983-0602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 CREEKSIDE DR SUITE 2100
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-3444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-983-2663
-----------------------------------------------------
Fax | 916-983-0602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. ROY A GREENBERG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 916-983-2663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | G036561
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------