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General NPI Number Information
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NPI Number | 1265438493
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Entity Type | Individual
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Provider Name | JAMES DOUGLAS GREEN JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 10475 CENTURION PKWY N STE 303
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5003
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Country | US
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Telephone | 904-399-0350
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Fax | 904-399-5914
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Provider Business Mailing Address
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Address Line | 11945 SAN JOSE BLVD BLDG 300
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1613
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Country | US
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Telephone | 904-396-1725
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Fax | 904-399-1717
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 58964
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | ME58964
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License Number State | FL
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