Individual
GERALD S GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1015 NW 22ND AVE, PORTLAND, OR 97210-3025
(503) 413-7711
(503) 227-0218
Mailing address
PO BOX 10768, PORTLAND, OR 97296-0768
(503) 227-2400
(503) 227-0218
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD7312
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263798
—
OR
Enumeration date
06/22/2006
Last updated
07/08/2007
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