-- JOHNNY BERT GREEN -- MD
Individual Provider (NPI-1)
Active
Colon & Rectal Surgery
Provider Information
- NPI Number
1386612414- Provider Type
- Individual Provider (NPI-1)
- Credentials
- MD
- Status
- Active
Contact & Location
- Address
- 1072 N LIBERTY STREET SUITE 201, BOISE, ID, 83704
- Phone
- (208) 302-2400
- Fax
- (208) 302-2455
Specialties & Taxonomies
Surgery
License: WA #35113
Colon & Rectal Surgery
License: WA #35113
Colon & Rectal Surgery
Primary License: ID #M-11186