NPI 1386612414

Johnny Bert Green, MD

Practitioner Colon & Rectal Surgery Physician Boise, ID

Practice location

Address: 1072 N Liberty Street Suite 201, Boise, ID 83704
Phone: (208) 302-2400
Fax: (208) 302-2455
Mailing address: 3340 E Goldstone Way, Meridian, ID 83642-1026

Registered specialties (3)

Colon & Rectal Surgery Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208C00000X Licence M-11186 (ID)

Other Colon & Rectal Surgery providers in Idaho →

Surgery Physician

Allopathic & Osteopathic Physicians Taxonomy 208600000X Licence 35113 (WA)

Other Surgery providers in Idaho →

Colon & Rectal Surgery Physician

Allopathic & Osteopathic Physicians Taxonomy 208C00000X Licence 35113 (WA)

Registry record

NPI: 1386612414
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Mar 2006
Record last updated: 15 Nov 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.