Individual
DR. BOB E GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19550 E 39TH ST S, SUITE 227, INDEPENDENCE, MO 64057-2303
(816) 795-9716
(816) 795-6358
Mailing address
10308 STATE LINE RD, SUITE A, LEAWOOD, KS 66206-2658
(913) 381-7117
(913) 383-1316
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
04-25504
KS
207RC0000X
Cardiovascular Disease Physician
MO112759
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100286810H
—
KS
05
—
1316946544
—
MO
05
—
208692103
—
MO
Enumeration date
07/19/2005
Last updated
06/14/2022
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