Provider Demographics
NPI:1003896408
Name:GREENBERG, DAVID M
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 IRON KING
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:81301-9417
Mailing Address - Country:US
Mailing Address - Phone:970-946-9017
Mailing Address - Fax:
Practice Address - Street 1:274 IRON KING
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-9417
Practice Address - Country:US
Practice Address - Phone:970-946-9017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22501207Q00000X
CO44207207Q00000X
NM2013-0110207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868945Medicaid
CO73338079Medicaid
CO44207OtherLICENSE
CO534514YNJOtherMEDICARE PTAN
NM07150717Medicaid
NM07150717Medicaid
G66265Medicare UPIN
320059Medicare Oscar/Certification
8HG432Medicare PIN