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General NPI Number Information
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NPI Number | 1417072190
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Entity Type | Organization
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Legal Business Name | J DOUGLAS GREEN JR MD PA
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 10475 CENTURION PKWY N SUITE 303
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City | JACKSONVILLE
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State | FL
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Zip | 32256
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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 | 10475 CENTURION PKWY N SUITE 303
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City | JACKSONVILLE
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State | FL
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Zip | 32256
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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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Authorized Official
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Title or Position | OTOLARYNGOLOGIST
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Name | DR. J DOUGLAS GREEN JR.
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Credential | M.D.
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Telephone | 904-399-0350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | ME0058964
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License Number State | FL
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