Individual
DR. KIRK DENNIS GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
400 N 17TH ST, KEOKUK, IA 52632-3452
(319) 524-5734
(319) 524-5758
Mailing address
400 N 17TH ST, KEOKUK, IA 52632-3452
(319) 524-5734
(319) 524-5758
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01737
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2308999
—
IA
01
—
54388
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/27/2005
Last updated
06/24/2010
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