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General NPI Number Information
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NPI Number | 1306020292
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Entity Type | Individual
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Provider Name | JON NORMAN GREEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 145 RADIANT CT
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City | WOODLAND PARK
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State | CO
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Zip | 80863-9073
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Country | US
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Telephone | 719-687-0850
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Fax | 508-300-5891
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Provider Business Mailing Address
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Address Line | 145 RADIANT CT
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City | WOODLAND PARK
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State | CO
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Zip | 80863-9073
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Country | US
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Telephone | 719-687-0850
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Fax | 508-300-5891
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 33056
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33056
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License Number State | CO
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