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General NPI Number Information
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NPI Number | 1831253426
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Entity Type | Organization
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Legal Business Name | SALMON CREEK PLASTIC SURGERY PC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 13712 NE 10TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98685-2628
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Country | US
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Telephone | 360-823-0860
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Fax | 360-828-1407
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Provider Business Mailing Address
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Address Line | 13712 NE 10TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98685-2628
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Country | US
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Telephone | 360-823-0860
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Fax | 360-828-1407
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Authorized Official
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Title or Position | PHYSICIAN AND OWNER
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Name | RICHARD KENNETH GREEN JR.
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Credential | M.D.
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Telephone | 360-574-7622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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