Healthcare Provider Details

I. General information

NPI: 1376450791
Provider Name (Legal Business Name): TANNER GREEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3753 DACORO LN
CASTLE ROCK CO
80109-2500
US

IV. Provider business mailing address

4001 S PEARL ST
ENGLEWOOD CO
80113-4737
US

V. Phone/Fax

Practice location:
  • Phone: 720-586-6901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: