Healthcare Provider Details

I. General information

NPI: 1265833982
Provider Name (Legal Business Name): JAMES GREEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CONGRESS AVE SUITE 207
BOYNTON BEACH FL
33426-3336
US

IV. Provider business mailing address

1101 N CONGRESS AVE SUITE 207
BOYNTON BEACH FL
33426-3336
US

V. Phone/Fax

Practice location:
  • Phone: 561-244-5424
  • Fax:
Mailing address:
  • Phone: 561-244-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 3526
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: