Individual
DR. JACOB T GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6750 E BAYWOOD AVE, 301, MESA, AZ 85206-1749
(480) 835-6100
(480) 505-5295
Mailing address
6402 E SUPERSTITION SPRINGS BLVD STE 224, MESA, AZ 85206-4394
(480) 835-6100
(480) 505-5295
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
054383
GA
207RC0000X
Cardiovascular Disease Physician
41389
AZ
207RI0011X
Interventional Cardiology Physician
Primary
41389
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424562
—
AZ
Enumeration date
12/28/2007
Last updated
06/08/2016
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