Provider Demographics
NPI:1952793416
Name:GREENBAUM, BRITTANY SARA (DO)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:SARA
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:SARA
Other - Last Name:BOGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2210 KING BLVD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3165
Mailing Address - Country:US
Mailing Address - Phone:307-577-4240
Mailing Address - Fax:307-577-0012
Practice Address - Street 1:2210 KING BLVD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3165
Practice Address - Country:US
Practice Address - Phone:307-577-4240
Practice Address - Fax:307-577-0012
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15701A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY224624400Medicaid