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NPI Code Detail

MEDICARE: DR. WILLIAM MACGREGOR GREEN MD

MEDICARE: DR. WILLIAM MACGREGOR 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
1207P00000XEmergency Medicine PhysicianG27289CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871591099
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM MACGREGOR GREEN MD
Provider Business Mailing Address
First Line : 1111 EMERALD BAY RD
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-6207
Country : US
Telephone Number : 530-543-5659
Fax Number : 530-541-8723
Provider Business Practice Location Address
First Line : 2170 SOUTH AVE
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-7026
Country : US
Telephone Number : 530-543-5968
Fax Number : 530-543-8683
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 09/20/2012

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Directions to “ DR. WILLIAM MACGREGOR GREEN MD” Practice Location

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