MEDICARE: WILLIAM JAMES 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
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	G70480	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00242841	OTHER	CA	RR MEDICARE

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
3	00G704800	OTHER	CA	BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891758686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JAMES GREEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 720300
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73172-0300
Country	:	US
Telephone Number	:	800-749-4560
Fax Number	:	405-749-4561

Provider Business Practice Location Address
First Line	:	ONE HOAG DR
Second Line	:	ECU DEPT.
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92658-6100
Country	:	US
Telephone Number	:	949-764-5689
Fax Number	:	405-749-4561

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	08/23/2010

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Directions to “ WILLIAM JAMES GREEN M.D.” Practice Location

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