Healthcare Provider Details

I. General information

NPI: 1033430764
Provider Name (Legal Business Name): JAMISON GREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EUREKA RD
ROSEVILLE CA
95661-3027
US

IV. Provider business mailing address

5820 OWENS DR. BUILDING E, 2ND FLOOR
PLEASANTON CA
94588-3900
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-4000
  • Fax:
Mailing address:
  • Phone: 925-737-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA135735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: