Provider Demographics
NPI:1043348436
Name:GREENBERG, LAWRENCE BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:BRUCE
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1499 W. 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732
Mailing Address - Country:US
Mailing Address - Phone:310-831-9482
Mailing Address - Fax:310-831-1230
Practice Address - Street 1:1499 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3255
Practice Address - Country:US
Practice Address - Phone:310-831-9482
Practice Address - Fax:310-831-1230
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG058769207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE52009Medicare UPIN