Individual provider · NPI-1

James Douglas Green, DO

Family Medicine · Peru, IN

NPI number1841273083
StatusActive
Last updated in NPPESSep 8, 2021

Details

NPI
1841273083
Entity type
Individual (NPI-1)
Name
James Douglas Green
Credential
DO
Sex
Male
Sole proprietor
No
Enumeration date
Nov 22, 2005
Certification date
Sep 8, 2021
Last updated
Sep 8, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine02001778AINYes

Practice location

750 N Broadway
Peru, IN 46970-1027

Phone 765-472-8907

Mailing address

750 N Broadway
Peru, IN 46970-1027

Phone 765-472-8907

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