Doctor Name: | MR. ROBERT NORMAN GREEN |
NPI Number: | 1407813199 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A13112 |
Business Practice Address: | 26072 Merit Cir Suite #119 Laguna Hills, CA - 926537015 |
Business Phone Number: | 9198596600 |
Business Fax Number: | |
Mailing Address: | 22991 Laurel Grove Cir, LAKE FOREST |
State: | CA |
Postal Code: | 926304025 |
Phone Number: | 9498596600 |
Fax Number: | 9498596600 |
NPI Enumeration Date: | 04/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A13112 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |