MEDICARE: DR. DOUGLAS ALLEN GREEN M.D., PH.D.

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	2085R0202X	Diagnostic Radiology Physician	3992-320	WI
2	2085R0202X	Diagnostic Radiology Physician	MC-207	GU
3	2085R0202X	Diagnostic Radiology Physician	MD-52680	IA
4	208D00000X	General Practice Physician	A100113	CA
5	2085N0700X	Neuroradiology Physician	A100113	CA
6	2085R0202X	Diagnostic Radiology Physician	A100113	CA
7	2085R0202X	Diagnostic Radiology Physician	16698C	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A1001130	OTHER	CA	BS OF CA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164635173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS ALLEN GREEN M.D., PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 2389
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92593-2389
Country	:	US
Telephone Number	:	951-600-3811
Fax Number	:

Provider Business Practice Location Address
First Line	:	31700 TEMECULA PKWY
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92592-5896
Country	:	US
Telephone Number	:	951-600-3811
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	11/21/2025

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Directions to “ DR. DOUGLAS ALLEN GREEN M.D., PH.D.” Practice Location

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