Healthcare Provider Details

I. General information

NPI: 1811997562
Provider Name (Legal Business Name): GREEN TREE ORTHOPEDICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 RAMSEY AVE SUITE A
GRANTS PASS OR
97527-5808
US

IV. Provider business mailing address

PO BOX 5010
GRANTS PASS OR
97527-0010
US

V. Phone/Fax

Practice location:
  • Phone: 541-244-2044
  • Fax: 541-471-1267
Mailing address:
  • Phone: 541-244-2044
  • Fax: 541-471-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number05360094
License Number StateOR

VIII. Authorized Official

Name: DR. JAMES D. DOWD
Title or Position: OWNER
Credential: M.D.
Phone: 541-244-2044