Healthcare Provider Details

I. General information

NPI: 1780856401
Provider Name (Legal Business Name): DR. ALLAN GREEN DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7656 N NOB HILL RD
TAMARAC FL
33321-1843
US

IV. Provider business mailing address

7656 N NOB HILL RD
TAMARAC FL
33321-1843
US

V. Phone/Fax

Practice location:
  • Phone: 954-724-3434
  • Fax:
Mailing address:
  • Phone: 954-724-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2261
License Number StateFL

VIII. Authorized Official

Name: DR. ALLAN LOWELL GREEN
Title or Position: DPM
Credential: DPM
Phone: 954-724-3434