Individual
SCOTT GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
141 W 22ND ST STE 311, ANDERSON, IN 46016-4389
(765) 647-7100
Mailing address
141 W 22ND ST, ANDERSON, IN 46016-4304
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01037111A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01037111A
STATE LICENSE
IN
01
—
080192608
RAILROAD INDIVIDUAL
IN
05
—
100099100
—
IN
05
—
100099100A
—
IN
01
—
CK6957
RAILROAD GROUP
IN
01
—
DC3600
RAILROAD GROUP
IN
01
—
P00714995
RAILROAD INDIVIDUAL
IN
Enumeration date
07/11/2006
Last updated
06/24/2022
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