Provider Demographics
NPI:1164522876
Name:GREENBERG, GEOFFREY M (M D)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:M
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1471
Mailing Address - Country:US
Mailing Address - Phone:509-452-5378
Mailing Address - Fax:509-577-7096
Practice Address - Street 1:111 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1471
Practice Address - Country:US
Practice Address - Phone:509-452-5378
Practice Address - Fax:509-577-7096
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD17581207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1001841Medicaid
WA61031OtherLABOR AND INDUSTRY
8850688Medicare ID - Type Unspecified
A15044Medicare UPIN