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Individual
CHARLES GARY GREEN
Active
Individual
CHARLES GARY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
G46958
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G469580
BLUE CROSS
—
05
—
00G469582
—
CA
01
—
5424723
MEDICAL PIN
—
Enumeration date
10/26/2006
Last updated
07/08/2007
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