Provider Demographics
NPI:1689700932
Name:GREEN, JULIAN A
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:A
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3529
Mailing Address - Country:US
Mailing Address - Phone:407-367-1560
Mailing Address - Fax:407-896-0247
Practice Address - Street 1:1010 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3529
Practice Address - Country:US
Practice Address - Phone:407-367-1560
Practice Address - Fax:407-896-0247
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator