Individual
GABRIEL ESTES GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1024 S LEMAY AVE, FORT COLLINS, CO 80524-3929
(303) 306-7783
(303) 306-7753
Mailing address
PO BOX 912215, DENVER, CO 80291-2215
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036.117244
IL
207P00000X
Emergency Medicine Physician
Primary
45414
CO
207P00000X
Emergency Medicine Physician
7812A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125149000
—
WY
05
—
98279246
—
CO
01
—
P00626871
RAILROAD MEDICARE
CO
01
—
S5008
BCBS
—
Enumeration date
04/13/2007
Last updated
05/13/2014
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