Provider Demographics
NPI:1699811224
Name:GREEN, JAMES CLIFFORD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CLIFFORD
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:105 WEST 8TH AVE
Mailing Address - Street 2:STE 408
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 WEST 8TH AVE
Practice Address - Street 2:STE 408
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2318
Practice Address - Country:US
Practice Address - Phone:509-455-8660
Practice Address - Fax:509-455-8662
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA00150232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA07202Medicare UPIN