MEDICARE: ANDY GREEN MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME86150	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083647788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDY GREEN MD PA

Provider Business Mailing Address
First Line	:	1380 NE MIAMI GARDENS DR
Second Line	:	STE 270
City	:	MIAMI
State	:	FL
Zip	:	33179-4721
Country	:	US
Telephone Number	:	305-945-2877
Fax Number	:	305-945-2878

Provider Business Practice Location Address
First Line	:	1380 NE MIAMI GARDENS DR
Second Line	:	STE 270
City	:	MIAMI
State	:	FL
Zip	:	33179-4721
Country	:	US
Telephone Number	:	305-945-2877
Fax Number	:	305-945-2878

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ANDY RAY GREEN
Credential	:	M.D., P.A.
Telephone Number	:	305-945-2877

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	09/17/2007

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Directions to “ANDY GREEN MD PA ” Practice Location

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