Provider Demographics
NPI:1376718940
Name:GEORGE E GREEN MD INC
Entity Type:Organization
Organization Name:GEORGE E GREEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-842-4466
Mailing Address - Street 1:9460 N NAME UNO STE 110
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3536
Mailing Address - Country:US
Mailing Address - Phone:408-842-4466
Mailing Address - Fax:408-848-1355
Practice Address - Street 1:9460 N NAME UNO STE 110
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3536
Practice Address - Country:US
Practice Address - Phone:408-842-4466
Practice Address - Fax:408-848-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG454410207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50042Medicare UPIN
CA00G454410Medicare PIN