MEDICARE: DR. GARTH TROY GREENWELL D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	O-0367	ID
2	208100000X	Physical Medicine & Rehabilitation Physician	20A11365	CA

General Provider Information

NPI Number	:	1578676789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARTH TROY GREENWELL D.O.

Provider Business Mailing Address
First Line	:	696 SAN RAMON VALLEY BLVD # 372
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4022
Country	:	US
Telephone Number	:	925-469-3120
Fax Number	:	925-924-1769

Provider Business Practice Location Address
First Line	:	5725 W LAS POSITAS BLVD
Second Line	:	SUITE 200
City	:	PLEASANTON
State	:	CA
Zip	:	94588-4054
Country	:	US
Telephone Number	:	925-469-6274
Fax Number	:	925-924-1769

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	01/14/2019

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