Healthcare Provider Details

I. General information

NPI: 1912040619
Provider Name (Legal Business Name): MATTHEW PRESTON GREEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

PO BOX 4045
SPRINGFIELD MO
65808-4045
US

V. Phone/Fax

Practice location:
  • Phone: 417-773-8200
  • Fax: 417-313-0898
Mailing address:
  • Phone: 417-773-8200
  • Fax: 417-313-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006018697
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: