Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME0064233 | FL |
NPI | 1053301655 |
---|---|
Provider Name | Dr. Howard Alen Green |
First Address | West Palm Beach, FL 33407 |
Second Address | West Palm Beach, FL 33407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 18/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F59000 | (02) |