Healthcare Provider Details

I. General information

NPI: 1215960059
Provider Name (Legal Business Name): CLARENCE S GREENE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE NEUROSURGERY DEPARTMENT
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

200 HENRY CLAY AVE NEUROSURGERY DEPARTMENT
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9568
  • Fax: 504-896-3966
Mailing address:
  • Phone: 504-896-9568
  • Fax: 504-896-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD.203792
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: