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Organization

MID-IOWA DERMATOLOGY, P. L. L. C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SCOTT GREGORY GREEN M.D. (PHYSICIAN)
(515) 955-4440
Entity
Organization

Contact information

Practice address
11 N 14TH ST, FORT DODGE, IA 50501-4241
(515) 955-4440
(515) 955-4449
Mailing address
11 N 14TH ST, FORT DODGE, IA 50501-4241
(515) 955-4440
(515) 955-4449

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
24935
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6137737
IA
Enumeration date
02/01/2012
Last updated
02/28/2012
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