=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164593182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD D GREENWOOD MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 SUNRISE AVE SUITE N
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-782-6700
-----------------------------------------------------
Fax | 916-782-6767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 SUNRISE AVE SUITE N
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-782-6700
-----------------------------------------------------
Fax | 916-782-6767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT CORPORATION PEDIATRICIAN
-----------------------------------------------------
Name | DR. RONALD D GREENWOOD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 916-782-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G21173
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------