Provider Demographics
NPI:1336569532
Name:GREENBURG, PATRICK TYLER
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:TYLER
Last Name:GREENBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 SW REGIONAL AIRPORT BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712
Mailing Address - Country:US
Mailing Address - Phone:479-254-7640
Mailing Address - Fax:479-254-2951
Practice Address - Street 1:7001 SW REGIONAL AIRPORT BLVD STE 1
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-254-7640
Practice Address - Fax:479-254-2951
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine