Provider Demographics
NPI:1982631735
Name:GREEN, JOSHUA B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:B
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 390028
Mailing Address - Street 2:
Mailing Address - City:KEAUHOU
Mailing Address - State:HI
Mailing Address - Zip Code:96739-0028
Mailing Address - Country:US
Mailing Address - Phone:808-937-0991
Mailing Address - Fax:
Practice Address - Street 1:54-383 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755-0010
Practice Address - Country:US
Practice Address - Phone:808-547-9593
Practice Address - Fax:808-599-2714
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 11173207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50056306Medicaid
HIH0221542OtherSHIELD/HMSA
HI101249Medicare ID - Type Unspecified
HI50056306Medicaid