Individual
DR. BRENT H. GREENWALD
Active
Individual
DR. BRENT H. GREENWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
M-6947
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010001551
BLUE SHIELD
ID
05
—
002786100
—
ID
01
—
76836
BLUE CROSS
ID
01
—
82-0529781
TAX ID NO
ID
01
—
8M987
BLUE CROSS PRACTICE
ID
Enumeration date
06/25/2006
Last updated
07/13/2009
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