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General NPI Number Information
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NPI Number | 1316946544
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Entity Type | Individual
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Provider Name | BOB E GREEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 19550 E 39TH ST S SUITE 227
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City | INDEPENDENCE
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State | MO
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Zip | 64057-2303
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Country | US
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Telephone | 816-795-9716
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Fax | 816-795-6358
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Provider Business Mailing Address
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Address Line | 10308 STATE LINE RD SUITE A
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City | LEAWOOD
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State | KS
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Zip | 66206-2658
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Country | US
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Telephone | 913-381-7117
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Fax | 913-383-1316
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MO112759
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 04-25504
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License Number State | KS
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