Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 000639 | MO |
N | 213ES0103X | Foot & Ankle Surgery | 12000254 | KS |
NPI | 1073550604 |
---|---|
Provider Name | Dr. Mark Alan Green |
First Address | Kansas City, MO 64114-4859 |
Second Address | Kansas City, MO 64114-4859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 22/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U12230 | (02) | MO |