Doctor Name: | CHADE B GREEN |
NPI Number: | 1093130783 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 5647 |
Business Practice Address: | 1600 North Main Lovington, NM - 882602813 |
Business Phone Number: | 5753966611 |
Business Fax Number: | 5753961454 |
Mailing Address: | Po Box 496, LOVINGTON |
State: | NM |
Postal Code: | 882600496 |
Phone Number: | 9282432141 |
Fax Number: | 5753961454 |
NPI Enumeration Date: | 03/04/2014 |
NPI Last Update Date: | 11/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 5647 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |