Individual
TED ALLEN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 N VIRGINIA AVE, EUREKA, MO 63025-1115
(636) 587-3000
(636) 587-2243
Mailing address
515 N VIRGINIA AVE, EUREKA, MO 63025-1115
(636) 587-3000
(636) 587-2243
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
106508
MO
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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