Provider Demographics
NPI:1740660430
Name:GREEN, CODY CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:CHRISTOPHER
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 1:7243 DELLA DR STE I
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5126
Mailing Address - Country:US
Mailing Address - Phone:321-428-0060
Mailing Address - Fax:321-842-0089
Practice Address - Street 1:7243 DELLA DR STE I
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5126
Practice Address - Country:US
Practice Address - Phone:321-428-0060
Practice Address - Fax:321-842-0089
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN21698207X00000X
NC2020-00293207X00000X
FLME150934207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0397730024OtherNSC#