MEDICARE: DR. EDWARD GREEN III 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	174400000X	Specialist	A71869	CA
2	207X00000X	Orthopaedic Surgery Physician	A71869	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A71869	OTHER	CA	CA LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467554220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD GREEN III M.D.

Provider Business Mailing Address
First Line	:	1040 ELM AVE
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3264
Country	:	US
Telephone Number	:	562-591-4444
Fax Number	:	562-436-7350

Provider Business Practice Location Address
First Line	:	1040 ELM AVE
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3264
Country	:	US
Telephone Number	:	562-591-4444
Fax Number	:	562-436-7350

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	01/12/2015

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