Individual
GARY M. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34 MARK WEST SPRINGS RD FL 3, SANTA ROSA, CA 95403
(707) 573-5234
(707) 573-5438
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(707) 573-5234
(707) 573-5438
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
G80599
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G805990
—
CA
01
—
G80599
STATE MEDICAL LICENSE
CA
Enumeration date
10/25/2006
Last updated
09/25/2019
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