Provider Demographics
NPI:1851736037
Name:GREEN, WESLEY C (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:C
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-3431
Mailing Address - Fax:314-362-6564
Practice Address - Street 1:517 S EUCLID AVE
Practice Address - Street 2:DEPT OPTHALMOLOGY, 1ST FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-362-3431
Practice Address - Fax:314-362-6564
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2024-04-25
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Provider Licenses
StateLicense IDTaxonomies
MO2017006915207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200043195Medicaid