MEDICARE: DR. LEWIS EDWARD GREEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME26938	FL

General Provider Information

NPI Number	:	1326248717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS EDWARD GREEN MD

Provider Business Mailing Address
First Line	:	6613 SAND CITY WAY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-5651
Country	:	US
Telephone Number	:	561-637-1802
Fax Number	:	561-637-1809

Provider Business Practice Location Address
First Line	:	6613 SAND CITY WAY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-5651
Country	:	US
Telephone Number	:	561-637-1802
Fax Number	:	561-637-1809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	03/04/2022

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