Healthcare Provider Details

I. General information

NPI: 1982625836
Provider Name (Legal Business Name): BERT GREEN, M.D., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16259 SYLVESTER RD SW SUITE 404
BURIEN WA
98166-3049
US

IV. Provider business mailing address

16259 SYLVESTER RD SW SUITE 404
BURIEN WA
98166-3049
US

V. Phone/Fax

Practice location:
  • Phone: 206-241-1818
  • Fax:
Mailing address:
  • Phone: 206-592-5000
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. BERT GREEN
Title or Position: OWNER
Credential: MD
Phone: 206-241-1818