Provider Demographics
NPI:1245325380
Name:GREEN, HOWARD J (DO)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:J
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6520 FORT CAROLINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2044
Mailing Address - Country:US
Mailing Address - Phone:904-745-3618
Mailing Address - Fax:904-722-4271
Practice Address - Street 1:14444 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2079
Practice Address - Country:US
Practice Address - Phone:904-367-2277
Practice Address - Fax:904-421-3788
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-07-07
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Provider Licenses
StateLicense IDTaxonomies
FLOS5883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE33436Medicare UPIN
FL80400BMedicare PIN
FL80400BMedicare PIN