Individual
DR. DEBORAH GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
315 PARK AVE, FORT LUPTON, CO 80621-1929
(303) 857-6111
(303) 857-2459
Mailing address
315 PARK AVE, FORT LUPTON, CO 80621-1929
(303) 857-6111
(303) 857-2459
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24133
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010022980
RR PTAN
CO
05
—
01241330
—
CO
Enumeration date
07/10/2006
Last updated
07/08/2010
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