Provider Demographics
NPI:1891247839
Name:DAVID MICHAEL GREENBERG, MD PLLC
Entity Type:Organization
Organization Name:DAVID MICHAEL GREENBERG, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-946-9017
Mailing Address - Street 1:274 IRON KING
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-9417
Mailing Address - Country:US
Mailing Address - Phone:970-946-9017
Mailing Address - Fax:
Practice Address - Street 1:274 IRON KING
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-9417
Practice Address - Country:US
Practice Address - Phone:970-946-9017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73338079Medicaid