MEDICARE: SCOTT L GREENBERG MD

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	M4120	TX
2	207RC0000X	Cardiovascular Disease Physician	M4120	TX
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	M4120	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CG969	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1083632293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT L GREENBERG MD

Provider Business Mailing Address
First Line	:	16980 DALLAS PKWY
Second Line	:	#200
City	:	DALLAS
State	:	TX
Zip	:	75248-1908
Country	:	US
Telephone Number	:	682-223-9120
Fax Number	:	682-223-9111

Provider Business Practice Location Address
First Line	:	1305 AIRPORT FWY
Second Line	:	301
City	:	BEDFORD
State	:	TX
Zip	:	76021-6605
Country	:	US
Telephone Number	:	682-223-9120
Fax Number	:	682-223-9111

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	04/23/2014

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Directions to “ SCOTT L GREENBERG MD” Practice Location

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