Individual
ROGER ELLIOTT GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
657 CAMINO DE LOS MARES, SUITE 242, SAN CLEMENTE, CA 92673
(949) 496-6066
(949) 496-6497
Mailing address
657 CAMINO DE LOS MARES, SUITE 242, SAN CLEMENTE, CA 92673-2826
(949) 496-6066
(949) 496-6497
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
C36384
CA
Other
Enumeration date
01/19/2006
Last updated
11/18/2009
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