Provider Demographics
NPI:1134431422
Name:GREEN, BENJAMIN JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
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 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3451
Mailing Address - Fax:319-358-2737
Practice Address - Street 1:540 E JEFFERSON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2477
Practice Address - Country:US
Practice Address - Phone:319-688-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8930208600000X
IA04689208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery