Provider Demographics
NPI:1306020292
Name:GREEN, JON NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:NORMAN
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:145 RADIANT CT
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-9073
Mailing Address - Country:US
Mailing Address - Phone:719-687-0850
Mailing Address - Fax:508-300-5891
Practice Address - Street 1:145 RADIANT CT
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-9073
Practice Address - Country:US
Practice Address - Phone:719-687-0850
Practice Address - Fax:508-300-5891
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33056207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine