Individual
RONALD W GREEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
703 RITTER DRIVE, BEAVER, WV 25813
(304) 255-1300
(304) 255-5391
Mailing address
PO BOX 550, BEAVER, WV 25813-0550
(304) 255-1300
(304) 255-5391
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
213
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720686
BLUE CROSS
WV
01
—
2103752
MAMSI
WV
Enumeration date
10/27/2005
Last updated
07/08/2007
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