Individual
DOUGLAS GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1350 S HICKORY STREET, MELBOURNE, FL 32901
(321) 254-6218
(321) 254-6230
Mailing address
PO BOX 361907, MELBOURNE, FL 32906-1907
(321) 254-6218
(321) 254-6230
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME0081481
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01899
BCBS
FL
05
—
260906100
—
FL
Enumeration date
01/17/2006
Last updated
02/15/2012
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