Provider Demographics
NPI:1750373098
Name:GREEN, JOSHUA T (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:T
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 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3325 S TAMIAMI TRL STE 200
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5114
Practice Address - Country:US
Practice Address - Phone:941-917-8488
Practice Address - Fax:941-917-8475
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69452208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260096000Medicaid
FL7707156OtherAETNA PROVIDER #
FL216498OtherAMERIGROUP PROV. #
FL340018101OtherMEDICARE RR
FL9479252OtherCIGNA PROVIDER #
FLP00449112OtherRAILROAD MEDICARE
FL1193067OtherWELLCARE
FL42437OtherBCBS
FL340018101OtherMEDICARE RR
FLE0019WMedicare PIN
FLG56395Medicare UPIN