Individual
TRAVIS RAY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4300 MARKET PTE DR STE 100, BLOOMINGTON, MN 55435-5435
(952) 767-4574
Mailing address
4300 MARKET PTE DR STE 100, BLOOMINGTON, MN 55435-5435
(952) 767-4574
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12938
MN
Other
Enumeration date
01/18/2019
Last updated
10/18/2023
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