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NPI Code Detail

MEDICARE: DR. ERIC GARY GREENBERG DO

MEDICARE: DR. ERIC GARY GREENBERG DO
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
1207Q00000XFamily Medicine Physician20A3676CA

General Provider Information

NPI Number : 1639161318
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC GARY GREENBERG DO
Provider Business Mailing Address
First Line : 3963 VIA PALO VERDE LAGO
Second Line :
City : ALPINE
State : CA
Zip : 91901-3217
Country : US
Telephone Number : 619-445-5505
Fax Number :
Provider Business Practice Location Address
First Line : 4058 WILLOWS RD
Second Line :
City : ALPINE
State : CA
Zip : 91901-1668
Country : US
Telephone Number : 619-445-1188
Fax Number : 619-445-0579
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 07/08/2007

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Directions to “ DR. ERIC GARY GREENBERG DO” Practice Location

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