Organization
W MICHAEL GREEN, MD INC
Active
Other names
Willam M Green, MD Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM MICHAEL GREEN M.D. (PRESIDENT)
(805) 482-6233
Entity
Organization
Contact information
Practice address
2309 ANTONIO AVE, PATHOLOGY DEPARTMENT, CAMARILLO, CA 93010-1414
(805) 389-5878
(805) 389-5883
Mailing address
PO BOX 986, CAMARILLO, CA 93011-0986
(805) 482-6233
(805) 389-5883
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G19218
BLUE SHIELD
—
05
—
GR0059650
—
CA
Enumeration date
09/23/2008
Last updated
09/23/2008
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