Green, Johnny Bert

Green, Johnny Bert is an individual health care provider with primary practice located at 1072 N Liberty Street Suite 201, Boise ID 83704. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Colon & Rectal Surgery. Allopathic & Osteopathic Physicians / Colon & Rectal Surgery is his primary health care specialty. Green, Johnny Bert can be contacted via phone (208) 302-2400.

Contact Information

Primary practice address
1072 N Liberty Street Suite 201 Boise ID 83704
Phone: (208) 302-2400
Fax: (208) 302-2455
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 35113 Washington
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 35113 Washington
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X M-11186 Idaho

Profile Details

NPI number 1386612414
LBN Legal business name Green, Johnny Bert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Nov 15th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386612414 NPPES
Idaho MEDICAID 1386612414

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