MEDICARE: STEPHEN E GREEN M.D.

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	207RC0000X	Cardiovascular Disease Physician	G39529	CA

General Provider Information

NPI Number	:	1376508606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN E GREEN M.D.

Provider Business Mailing Address
First Line	:	2400 SAMARITAN DR
Second Line	:	SUITE 200
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3910
Country	:	US
Telephone Number	:	408-369-7500
Fax Number	:	408-558-6940

Provider Business Practice Location Address
First Line	:	2400 SAMARITAN DR
Second Line	:	SUITE 200
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3910
Country	:	US
Telephone Number	:	408-369-7500
Fax Number	:	408-558-6940

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	06/27/2014

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