Individual
PRESTON T GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13575 NW 1ST LN STE 20, NEWBERRY, FL 32669-3735
(352) 332-5755
(855) 964-1167
Mailing address
13575 NW 1ST LN STE 20, NEWBERRY, FL 32669-3735
(352) 332-5755
(855) 964-1157
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME45509
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045242400
—
FL
01
—
08433
BCBS
FL
01
—
P1007245
AVMED
FL
Enumeration date
07/11/2006
Last updated
11/08/2024
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