Healthcare Provider Details

I. General information

NPI: 1700893179
Provider Name (Legal Business Name): JAMES R GREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD
GAINESVILLE FL
32605-4309
US

IV. Provider business mailing address

4131 NW 13TH ST SUITE 101
GAINESVILLE FL
32609-1858
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4180
  • Fax: 352-333-4861
Mailing address:
  • Phone: 352-376-1887
  • Fax: 352-375-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME0044699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: