Provider Demographics
NPI:1356491989
Name:DAVID L GREENSPAN MD PLLC
Entity Type:Organization
Organization Name:DAVID L GREENSPAN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-234-1300
Mailing Address - Street 1:600 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4213
Mailing Address - Country:US
Mailing Address - Phone:602-234-1300
Mailing Address - Fax:602-234-0202
Practice Address - Street 1:600 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4213
Practice Address - Country:US
Practice Address - Phone:602-234-1300
Practice Address - Fax:602-234-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28350207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ525743Medicaid
AZZ112446Medicare PIN
AZ525743Medicaid