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NPI Code Detail

MEDICARE: JOHN J GREEN DO PA

MEDICARE: JOHN J GREEN DO 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
1207R00000XInternal Medicine PhysicianOS 8155FL

General Provider Information

NPI Number : 1336353135
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN J GREEN DO PA
Provider Business Mailing Address
First Line : 15880 SUMMERLIN RD
Second Line : PMB 207
City : FORT MYERS
State : FL
Zip : 33908-9612
Country : US
Telephone Number : 239-332-4099
Fax Number : 239-332-4088
Provider Business Practice Location Address
First Line : 14131 METROPOLIS AVENUE
Second Line : SUITE 104
City : FORT MYERS
State : FL
Zip : 33912-4336
Country : US
Telephone Number : 239-332-4099
Fax Number : 239-332-4088
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOHN JUSTIN GREEN
Credential : D.O.
Telephone Number : 239-332-4099
Provider Enumeration Date : 05/10/2007
Last Update Date : 01/06/2009

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