Organization
W MICHAEL GREEN, MD INC
Active
Other names
Wm Michael Green MD Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
WM MICHAEL GREEN MD (PRESIDENT)
(805) 988-2644
Entity
Organization
Contact information
Practice address
1600 N ROSE AVE, OXNARD, CA 93030-3722
(805) 988-2644
Mailing address
PO BOX 25420, VENTURA, CA 93002-2277
(805) 650-5910
(805) 650-5972
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0059650
—
CA
01
—
ZZZ42071Z
BLUE SHIELD
CA
Enumeration date
12/04/2006
Last updated
06/19/2008
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