Provider Demographics
NPI:1548370968
Name:GREENSPAN, AVRAM C (MD)
Entity type:Individual
Prefix:DR
First Name:AVRAM
Middle Name:C
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37202 N 102ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-3124
Mailing Address - Country:US
Mailing Address - Phone:650-704-5480
Mailing Address - Fax:480-718-8324
Practice Address - Street 1:37202 N 102ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-3124
Practice Address - Country:US
Practice Address - Phone:650-704-5480
Practice Address - Fax:480-718-8324
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20489208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty