MEDICARE: DR. JAMES R GREEN SR. MD

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	207X00000X	Orthopaedic Surgery Physician	05615	MS

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	:	1134122484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R GREEN SR. MD

Provider Business Mailing Address
First Line	:	PO BOX 5378
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-5378
Country	:	US
Telephone Number	:	601-693-6663
Fax Number	:	601-693-6665

Provider Business Practice Location Address
First Line	:	2024 15TH ST
Second Line	:	STE 4N
City	:	MERIDIAN
State	:	MS
Zip	:	39301-4130
Country	:	US
Telephone Number	:	601-693-6663
Fax Number	:	601-693-6665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/17/2012

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