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Individual

MR. GREGORY E. GREEN SR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
2000 NW 119TH ST APT 903, MIAMI, FL 33167-2746
(786) 261-5642
Mailing address
2000 NW 119TH ST APT 903, MIAMI, FL 33167-2746
(786) 261-5642

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-9104265
FL

Other

Enumeration date
03/17/2009
Last updated
03/17/2009
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