Individual
JEFF C GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 GWEE SHUT RD, SILETZ, OR 97380-2036
(541) 444-9613
Mailing address
200 GWEE SHUT RD, SILETZ, OR 97380-2036
(541) 444-9613
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
8371309
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8989
—
OR
Enumeration date
05/25/2022
Last updated
05/25/2022
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