Individual
MR. CHARLES PERRY GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3361 NO KID RD, KAMIAH, ID 83536-5002
(208) 553-0284
(208) 935-2329
Mailing address
3361 NO KID RD, KAMIAH, ID 83536-5002
(208) 553-0284
(208) 935-2329
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
003866467
ID
Other
Enumeration date
12/19/2011
Last updated
12/19/2011
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