Provider Demographics
NPI:1659310324
Name:GREEN, JOAN MARIE (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 W DICKERSON ST STE 207
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6851
Mailing Address - Country:US
Mailing Address - Phone:406-586-9735
Mailing Address - Fax:406-582-9158
Practice Address - Street 1:1940 W DICKERSON ST STE 207
Practice Address - Street 2:SUITE 207
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6851
Practice Address - Country:US
Practice Address - Phone:406-586-9735
Practice Address - Fax:406-582-9158
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT83232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTF31092Medicare UPIN
MT010001558Medicare ID - Type Unspecified