Healthcare Provider Details

I. General information

NPI: 1770674517
Provider Name (Legal Business Name): JENNIFER BRIGITTE GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DUKE UNIVERSITY MEDICAL CENTER/ DIV OF ENDOCRINOLOGY DUMC BOX 3222, BAKER HOUSE ROOM 280
DURHAM NC
27710-0001
US

IV. Provider business mailing address

DUKE UNIVERSITY MEDICAL CENTER/ DIV OF ENDOCRINOLOGY DUMC BOX 3222, BAKER HOUSE ROOM 280
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-5568
  • Fax: 919-681-7796
Mailing address:
  • Phone: 919-684-5568
  • Fax: 919-681-7796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number9600554
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: