Individual
ADAM W. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3101 SE 14TH ST, BENTONVILLE, AR 72712-4900
(479) 986-6199
(479) 636-0371
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(314) 543-6979
(314) 364-6321
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
E-8330
AR
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
E-8330
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861620213
—
MO
05
—
204518001
—
AR
01
—
P01507946
RR MEDICARE
AR
Enumeration date
06/24/2009
Last updated
12/04/2023
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