Provider Demographics
NPI:1235467358
Name:GREEN, KENDALL BRYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:BRYCE
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2400 TUCKER
Mailing Address - Street 2:FAMILY PRACTICE CENTER RM 232
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-8043
Mailing Address - Fax:505-272-8044
Practice Address - Street 1:2400 TUCKER
Practice Address - Street 2:FAMILY PRACTICE CENTER RM 232
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-8043
Practice Address - Fax:505-272-8044
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2009-06742083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine