Provider Demographics
NPI:1932396058
Name:PETER GREENBERG, MD INC
Entity Type:Organization
Organization Name:PETER GREENBERG, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-691-5123
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-0575
Mailing Address - Country:US
Mailing Address - Phone:951-691-5123
Mailing Address - Fax:951-691-5156
Practice Address - Street 1:1180 N INDIAN CANYON DR STE E218
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4885
Practice Address - Country:US
Practice Address - Phone:951-691-5123
Practice Address - Fax:951-691-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48958261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0063580Medicaid
CAGR0063580Medicaid
CAZZZ43888ZMedicare PIN