Healthcare Provider Details

I. General information

NPI: 1447600655
Provider Name (Legal Business Name): CHRISTOPHER RYAN GREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2016
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE FL 5
NEW ORLEANS LA
70112-2600
US

IV. Provider business mailing address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5263
  • Fax:
Mailing address:
  • Phone: 415-353-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number125069469
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number168965
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number333012
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: