Individual
BRYAN ROBERT GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2016 S MAIN ST, MARYVILLE, MO 64468-2655
(660) 562-7999
(660) 562-7996
Mailing address
2016 S MAIN ST, MARYVILLE, MO 64468-2655
(660) 562-2525
(660) 562-7996
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2005034471
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295791366
TRICARE
MO
05
—
1295791366
—
IA
05
—
1295791366
—
MO
05
—
201084370A
—
KS
01
—
49561031
BCBSKC
MO
01
—
P00273140
RR MEDICARE
MO
Enumeration date
04/26/2006
Last updated
10/09/2024
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