Provider Demographics
NPI:1134172901
Name:GREENGART, DAVID JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JONATHAN
Last Name:GREENGART
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 1:2919 SHENANDOAH VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3141
Mailing Address - Country:US
Mailing Address - Phone:501-312-1993
Mailing Address - Fax:
Practice Address - Street 1:2919 SHENANDOAH VALLEY DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3141
Practice Address - Country:US
Practice Address - Phone:501-312-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4595207P00000X
MO2008003303207P00000X
IL036.117655207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1134172901Medicaid
AR159424001Medicaid
IL036117655Medicaid
MO1134172901OtherBLUE CROSS BLUE SHIELD
IL036117655-6Medicaid
AR5N438Medicare ID - Type Unspecified
ILK41208Medicare PIN
MO1134172901Medicaid
ILK41178Medicare PIN
IL036117655-6Medicaid
MO147400025Medicare PIN
AR159424001Medicaid