Provider Demographics
NPI:1891758686
Name:GREEN, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
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:PO BOX 720300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73172-0300
Mailing Address - Country:US
Mailing Address - Phone:800-749-4560
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:ONE HOAG DR
Practice Address - Street 2:ECU DEPT.
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92658-6100
Practice Address - Country:US
Practice Address - Phone:949-764-5689
Practice Address - Fax:405-749-4561
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70480207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G704800670Medicaid
CAP00242841OtherRR MEDICARE
CA00G704800OtherBLUE SHIELD
CA00G704800Medicaid
CA00G704800670Medicaid
CA00G704800Medicaid