Individual
JERRIL GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14319 SAINT MICHAEL DR, LITTLE ROCK, AR 72211-5572
(501) 590-2885
Mailing address
14319 SAINT MICHAEL DR, LITTLE ROCK, AR 72211-5572
(501) 590-2885
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
E-1961
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135223001
—
AR
Enumeration date
10/13/2006
Last updated
11/12/2014
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