Individual
JUSTIN D GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5277 MANHATTAN CIR, SUITE 100, BOULDER, CO 80303-8201
(720) 304-8154
Mailing address
PO BOX 1588, BOULDER, CO 80306-1588
(303) 442-5492
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
32177
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01321777
—
CO
Enumeration date
12/27/2006
Last updated
07/08/2007
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