Provider Demographics
NPI:1285837120
Name:WALTER S GREEN, M.D. MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WALTER S GREEN, M.D. MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-923-3001
Mailing Address - Street 1:8345 FIRESTONE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3872
Mailing Address - Country:US
Mailing Address - Phone:562-923-3001
Mailing Address - Fax:
Practice Address - Street 1:8345 FIRESTONE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3872
Practice Address - Country:US
Practice Address - Phone:562-923-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA09766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA18313Medicare UPIN
CAA09766Medicare ID - Type Unspecified