Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A86727 | CA |
N | 207Q00000X | Family Doctor | A86727 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | A86727 | CA |
N | 207R00000X | Internist | A86727 | CA |
N | 111NI0900X | Internist | A86727 | CA |
NPI | 1013927441 |
---|---|
Provider Name | Greg A Greenberg |
First Address | Redding, CA 96001-0166 |
Second Address | Redding, CA 96001-0852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 28/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A867270 | (05) | CA |
I05668 | (02) | CA |