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General NPI Number Information
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NPI Number | 1972765253
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Entity Type | Individual
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Provider Name | BRAD GREEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 126 W 82ND ST APT 1
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City | NEW YORK
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State | NY
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Zip | 10024-5584
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Country | US
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Telephone | 571-338-1966
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Fax |
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Provider Business Mailing Address
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Address Line | 6835 E CAMELBACK RD UNIT 5005
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-3156
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Country | US
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Telephone | 571-338-1966
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD2020-0058
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35.124189
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License Number State | OH
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