Provider Demographics
NPI:1346240330
Name:GREENWOOD, J. MURRAY III (MD)
Entity type:Individual
Prefix:
First Name:J. MURRAY
Middle Name:
Last Name:GREENWOOD
Suffix:III
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:214-590-4105
Mailing Address - Fax:214-590-4162
Practice Address - Street 1:3310 LIVE OAK ST
Practice Address - Street 2:YOUTH & FAMILY CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6153
Practice Address - Country:US
Practice Address - Phone:214-266-1257
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH62552080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF74617Medicare UPIN
TX84674FMedicare ID - Type UnspecifiedD62C