Provider Demographics
NPI:1053482554
Name:NIRENBERG, NEAL A (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:A
Last Name:NIRENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5620 E BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1438
Mailing Address - Country:US
Mailing Address - Phone:480-981-6111
Mailing Address - Fax:480-985-2426
Practice Address - Street 1:5620 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1438
Practice Address - Country:US
Practice Address - Phone:480-981-6111
Practice Address - Fax:480-985-2426
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25484207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z0841OtherHEALTHNET
AZCN9576OtherRR MEDICARE GROUP NUMBER
AZAZ210795OtherSECURE HORIZON BPHO
AZAZ0887960OtherBLUE CROSS BLUE SHIELD
AZ39600304Medicaid
AZ65741Medicare ID - Type UnspecifiedNIRENBERG MED INDIVIDUAL
AZCN9576OtherRR MEDICARE GROUP NUMBER
AZ39600304Medicaid