MEDICARE: JOAN MARIE GREEN 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	2084P0804X	Child & Adolescent Psychiatry Physician	8323	MT

General Provider Information

NPI Number	:	1659310324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN MARIE GREEN MD

Provider Business Mailing Address
First Line	:	1940 W DICKERSON ST STE 207
Second Line	:	SUITE 207
City	:	BOZEMAN
State	:	MT
Zip	:	59718-6851
Country	:	US
Telephone Number	:	406-586-9735
Fax Number	:	406-582-9158

Provider Business Practice Location Address
First Line	:	1940 W DICKERSON ST STE 207
Second Line	:	SUITE 207
City	:	BOZEMAN
State	:	MT
Zip	:	59718-6851
Country	:	US
Telephone Number	:	406-586-9735
Fax Number	:	406-582-9158

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	03/22/2017

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