Provider Demographics
NPI:1386625945
Name:GREENBERG, MINDY (PA-C, MS)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:GI LAB, 111B1
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-4160
Mailing Address - Fax:214-462-4512
Practice Address - Street 1:4500 SOUTH LANCASTER ROAD
Practice Address - Street 2:GI LAB, 111B1
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-0000
Practice Address - Country:US
Practice Address - Phone:214-857-4160
Practice Address - Fax:214-462-4512
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03067363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant