Individual
KIRBY ARNESTO GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2290 SOUTH 1300 EAST, MEDICAL MARTS, SALT LAKE CITY, UT 84106-2831
(801) 474-0800
(810) 467-1126
Mailing address
2290 S 1300 E, SALT LAKE CITY, UT 84106-2831
(801) 474-0800
(801) 467-1126
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
014738
LA
207R00000X
Internal Medicine Physician
6053966-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194841
—
LA
05
—
200785958001
—
UT
Enumeration date
07/07/2006
Last updated
11/07/2007
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