MEDICARE: DR. JAMES DOUGLAS GREEN JR. M.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	174400000X	Specialist	58964	FL
2	207YX0901X	Otology & Neurotology Physician	ME58964	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265438493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DOUGLAS GREEN JR. M.D.

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-399-1717

Provider Business Practice Location Address
First Line	:	10475 CENTURION PKWY N
Second Line	:	STE 303
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-5003
Country	:	US
Telephone Number	:	904-399-0350
Fax Number	:	904-399-5914

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	04/14/2026

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Directions to “ DR. JAMES DOUGLAS GREEN JR. M.D.” Practice Location

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