Organization
TREASURE VALLEY COLON & RECTAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNNY B GREEN M.D. (PRESIDENT)
(208) 377-2273
Entity
Organization
Contact information
Practice address
1072 N LIBERTY ST, SUITE 201, BOISE, ID 83704-8706
(208) 377-2273
(208) 367-3059
Mailing address
1072 N LIBERTY ST, SUITE 201, BOISE, ID 83704-8706
(208) 377-2273
(208) 367-3059
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
M11186
ID
208C00000X
Colon & Rectal Surgery Physician
Primary
M11186
ID
Other
Enumeration date
02/08/2011
Last updated
03/22/2011
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