Provider Demographics
NPI:1760434674
Name:GREENBERG, DAVID C (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11500 NE 76TH ST STE A3
Mailing Address - Street 2:PMB 7
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3901
Mailing Address - Country:US
Mailing Address - Phone:503-257-8886
Mailing Address - Fax:503-251-1892
Practice Address - Street 1:948 NE 102ND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4064
Practice Address - Country:US
Practice Address - Phone:503-257-8886
Practice Address - Fax:503-251-1892
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDP00129213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR001487000OtherREGENCE BLUE CROSS
WA1006360Medicaid
OR756480632OtherMEDICARE RAILROAD
OR16851-8Medicaid
OR93075402-9722-A002OtherTRICARE
OR0313830001Medicare NSC
ORT67669Medicare UPIN