Provider Demographics
NPI:1285671834
Name:GREEN, JAMES A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1509 ZENITH WAY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2322
Mailing Address - Country:US
Mailing Address - Phone:954-435-2700
Mailing Address - Fax:888-521-3029
Practice Address - Street 1:21097 NE 27TH CT STE 370
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1234
Practice Address - Country:US
Practice Address - Phone:305-935-6566
Practice Address - Fax:888-521-3029
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1378213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87713Medicare ID - Type UnspecifiedMEDICARE
FL87713Medicare PIN
U17595Medicare UPIN