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General NPI Number Information
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NPI Number | 1194909804
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Entity Type | Organization
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Legal Business Name | DEBORAH GREEN MD PC
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 315 PARK AVE
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City | FORT LUPTON
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State | CO
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Zip | 80621-1929
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Country | US
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Telephone | 303-857-6111
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Fax | 303-857-2459
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Provider Business Mailing Address
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Address Line | 315 PARK AVE
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City | FORT LUPTON
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State | CO
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Zip | 80621-1929
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Country | US
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Telephone | 303-857-6111
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Fax | 303-857-2459
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Authorized Official
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Title or Position | OWNER
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Name | NANCY SALAS
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Credential | MD PC
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Telephone | 303-857-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 241330
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License Number State | CO
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