Provider Demographics
NPI:1417984600
Name:GREENSPUN, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GREENSPUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WILSHIRE BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1854
Mailing Address - Country:US
Mailing Address - Phone:310-829-8945
Mailing Address - Fax:424-212-5934
Practice Address - Street 1:901 WILSHIRE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1854
Practice Address - Country:US
Practice Address - Phone:310-829-8903
Practice Address - Fax:424-212-5933
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine