Healthcare Provider Details

I. General information

NPI: 1043848260
Provider Name (Legal Business Name): ALLEN GREEN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY FRONTAGE RD STE 370
MILL VALLEY CA
94941-3057
US

IV. Provider business mailing address

655 REDWOOD HWY FRONTAGE RD STE 370
MILL VALLEY CA
94941-3057
US

V. Phone/Fax

Practice location:
  • Phone: 415-928-1352
  • Fax:
Mailing address:
  • Phone: 415-928-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberU4809
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA204398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: