Healthcare Provider Details

I. General information

NPI: 1417303793
Provider Name (Legal Business Name): JAMES ALLAN DENISAR-GREEN M.D., PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S 27TH ST
BILLINGS MT
59101-4227
US

IV. Provider business mailing address

123 S 27TH ST
BILLINGS MT
59101-4227
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-3350
  • Fax: 406-247-3389
Mailing address:
  • Phone: 406-247-3350
  • Fax: 406-247-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60969576
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number96797
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: