Healthcare Provider Details

I. General information

NPI: 1316096167
Provider Name (Legal Business Name): AGNES P GREEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7315 HUDSON AVE
HUDSON FL
34667-1158
US

IV. Provider business mailing address

PO BOX 5477
HUDSON FL
34674-5477
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-9563
  • Fax: 727-869-6909
Mailing address:
  • Phone: 727-868-9563
  • Fax: 727-869-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME92890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: