Healthcare Provider Details

I. General information

NPI: 1770522831
Provider Name (Legal Business Name): JEFFREY SCOTT GREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 S 22ND AVE STE 3
BOZEMAN MT
59718-7054
US

IV. Provider business mailing address

1871 S 22ND AVE STE 3
BOZEMAN MT
59718-7054
US

V. Phone/Fax

Practice location:
  • Phone: 406-582-9306
  • Fax: 406-205-1459
Mailing address:
  • Phone: 406-582-9306
  • Fax: 406-205-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number8322
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: