Individual
THOMAS JUSTIN GREEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1673 MASON AVE, SUITE 305, DAYTONA BEACH, FL 32117-5515
(386) 274-7118
(386) 274-6173
Mailing address
1673 MASON AVE STE 305, DAYTONA BEACH, FL 32117-5516
(386) 274-7118
(386) 274-6173
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
ME 86894
FL
2085N0700X
Neuroradiology Physician
ME 86894
FL
2085N0904X
Nuclear Radiology Physician
ME 86894
FL
2085P0229X
Pediatric Radiology Physician
ME 86894
FL
2085R0202X
Diagnostic Radiology Physician
Primary
0101102736
VA
2085R0202X
Diagnostic Radiology Physician
103916
GA
2085R0202X
Diagnostic Radiology Physician
ME86894
FL
2085R0203X
Therapeutic Radiology Physician
ME 86894
FL
2085R0204X
Vascular & Interventional Radiology Physician
ME86894
FL
2085U0001X
Diagnostic Ultrasound Physician
ME 86894
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267313400
—
FL
01
—
79205
BCBS OF FLORIDA
FL
Enumeration date
07/07/2005
Last updated
10/01/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us