Individual
MR. THOMAS J GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114
(386) 254-4139
(386) 258-8265
Mailing address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 258-7668
(386) 258-7671
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME0021283
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069212300
—
FL
Enumeration date
03/23/2006
Last updated
06/30/2010
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