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General NPI Number Information
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NPI Number | 1922188937
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Entity Type | Organization
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Legal Business Name | CLARE GREEN, DO
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1881 NW 185TH AVE STE 102
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City | ALOHA
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State | OR
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Zip | 97006-8914
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Country | US
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Telephone | 503-439-1539
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Fax | 503-439-8960
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Provider Business Mailing Address
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Address Line | 1881 NW 185TH AVE STE 102
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City | ALOHA
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State | OR
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Zip | 97006-8914
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Country | US
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Telephone | 503-439-1539
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Fax | 503-439-8960
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLARE A GREEN
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Credential | DO
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Telephone | 503-439-1539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO23355
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License Number State | OR
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