Healthcare Provider Details

I. General information

NPI: 1376508606
Provider Name (Legal Business Name): STEPHEN E GREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 SAMARITAN DR SUITE 200
SAN JOSE CA
95124-3910
US

IV. Provider business mailing address

2400 SAMARITAN DR SUITE 200
SAN JOSE CA
95124-3910
US

V. Phone/Fax

Practice location:
  • Phone: 408-369-7500
  • Fax: 408-558-6940
Mailing address:
  • Phone: 408-369-7500
  • Fax: 408-558-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG39529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: