Provider Demographics
NPI:1568445997
Name:GREENBERG, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:GREENBERG
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 1:6628 NW 9TH BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4282
Mailing Address - Country:US
Mailing Address - Phone:352-331-1155
Mailing Address - Fax:352-331-3371
Practice Address - Street 1:6628 NW 9TH BLVD
Practice Address - Street 2:STE 4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4282
Practice Address - Country:US
Practice Address - Phone:352-331-1155
Practice Address - Fax:352-331-3371
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME13988207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053664400Medicaid
FL01906OtherBCBS OF FLORIDA
01906Medicare ID - Type Unspecified
FL053664400Medicaid