Provider Demographics
NPI:1639136849
Name:GREEN, DARRIN (MD)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 COMPASS DR STE 377
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8723
Mailing Address - Country:US
Mailing Address - Phone:970-241-2212
Mailing Address - Fax:970-257-2401
Practice Address - Street 1:725 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4222
Practice Address - Country:US
Practice Address - Phone:970-240-7734
Practice Address - Fax:970-240-7263
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05982553Medicaid
COC804135Medicare PIN