Individual
DR. CHARLES PATRICK GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 E HARMONY RD, UNIT 100, FORT COLLINS, CO 80528-3401
(970) 221-1000
(970) 297-6860
Mailing address
2121 E HARMONY RD, SUITE 100, FORT COLLINS, CO 80528-3400
(970) 221-1000
(970) 297-6860
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
21397
NE
207RC0000X
Cardiovascular Disease Physician
Primary
37999
CO
207RC0000X
Cardiovascular Disease Physician
6263A
WY
207UN0901X
Nuclear Cardiology Physician
37999
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114732300
—
WY
05
—
36377066
—
CO
01
—
P00977662
MEDICARE RAILROAD PTAN
NE
Enumeration date
06/21/2005
Last updated
03/22/2016
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