Individual
JEFFERY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 MEDICAL CENTER DR, FAIRMONT, MN 56031-4575
(507) 238-8555
Mailing address
800 MEDICAL CENTER DR, FAIRMONT, MN 56031-4575
(507) 238-8555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42651
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007R5GR
BCBS
MN
05
—
007R5GR
—
MN
01
—
01-13052
MEDICA
MN
01
—
1053638
ARAZ
MN
05
—
150697
—
FM
01
—
20227
SIOUX VALLEY
MN
05
—
3153445
—
MN
05
—
398640300
—
MN
01
—
A037
CHAMPUS
MN
01
—
HP30910
HEALTH PARTNERS
MN
01
—
MH9041024627
PPO
MN
Enumeration date
12/06/2005
Last updated
09/17/2020
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