Provider Demographics
NPI:1568552859
Name:GREENBERG, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:77840 FLORA RD
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-4109
Practice Address - Country:US
Practice Address - Phone:760-200-8777
Practice Address - Fax:760-200-8877
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48958174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00703711OtherRAILROAD MEDICARE
CA00G489580OtherBLUE SHIELD / TRICARE CALI.
CAGR0063580Medicaid
CA4103385OtherAETNA
CAP00703711OtherRAILROAD MEDICARE
CAA51224Medicare UPIN
CAGR0063580Medicaid
CAAQ598WMedicare PIN
CAAQ598YMedicare PIN
CA00G489580Medicare PIN