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NPI Code Detail

MEDICARE: DR. BILLIE GREEN M.D.

MEDICARE: DR. BILLIE GREEN 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
1207R00000XInternal Medicine Physician07510RLA
2207R00000XInternal Medicine PhysicianA44412CA

Other Identifiers

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

General Provider Information

NPI Number : 1427048032
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BILLIE GREEN M.D.
Provider Business Mailing Address
First Line : 1101 FELSPAR ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-2925
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1101 FELSPAR ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-2925
Country : US
Telephone Number : 858-483-1720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 03/03/2020

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Directions to “ DR. BILLIE GREEN M.D.” Practice Location

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