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General NPI Number Information
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NPI Number | 1477679496
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Entity Type | Individual
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Provider Name | STEPHEN LLOYD GREEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 02/22/2013
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Provider Practice Location Address
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Address Line | 2131 S BONITO WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1659
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Country | US
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Telephone | 208-489-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 26 TOWN CENTER WAY # 704
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City | HAMPTON
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State | VA
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Zip | 23666-1999
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Country | US
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Telephone | 757-771-8049
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Fax | 757-851-1285
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 0101028335
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | M-10266
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License Number State | ID
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