Organization
KITSAP COLORECTAL SURGERY INC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNNY B GREEN MD (PRESIDENT)
(360) 377-4717
Entity
Organization
Contact information
Practice address
2528 WHEATON WAY, SUITE 103, BREMERTON, WA 98310-3305
(360) 377-4717
(360) 377-4134
Mailing address
2528 WHEATON WAY, SUITE 103, BREMERTON, WA 98310-3305
(360) 377-4717
(360) 377-4134
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35113
WA
208C00000X
Colon & Rectal Surgery Physician
35113
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1109032
—
WA
Enumeration date
10/23/2009
Last updated
10/23/2009
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