Individual
BRUCE KEVIN GREENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 FAIRVIEW HEIGHTS RD, SUMMERSVILLE, WV 26651-1085
(304) 872-5090
(304) 872-0636
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17260
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0053729000
—
WV
01
—
550775750
TAX ID
—
Enumeration date
10/13/2005
Last updated
04/21/2022
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