Provider Demographics
NPI:1235149154
Name:BRODSKY, GRETA VANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETA
Middle Name:VANCE
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3417 GASTON AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-823-4800
Mailing Address - Fax:214-823-4801
Practice Address - Street 1:3417 GASTON AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-823-4800
Practice Address - Fax:214-823-4801
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ2915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046190701Medicaid
TX87X761OtherBCBS
TX87X761OtherBCBS
TXF79755Medicare UPIN
TX110126731Medicare PIN