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NPI Code Detail

MEDICARE: NIKKI LAUDERBACK GREENSPAN

MEDICARE: NIKKI LAUDERBACK GREENSPAN
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
1208D00000XGeneral Practice PhysicianV4138TX
2207P00000XEmergency Medicine PhysicianV4138TX

General Provider Information

NPI Number : 1093414534
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKKI LAUDERBACK GREENSPAN
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78234-4504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : JBSA FT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-916-4789
Fax Number : 210-916-6654
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2023
Last Update Date : 05/06/2026

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Directions to “ NIKKI LAUDERBACK GREENSPAN ” Practice Location

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