JOHNNY BERT GREEN MD NPI 1386612414

NPI Information

NPI: 1386612414
Provider Name: JOHNNY BERT GREEN, MD
Classification: Colon & Rectal Surgery - 208C00000X
Entity Type: Individual
Address:
1072 N LIBERTY STREET
SUITE 201
BOISE, ID
ZIP 83704
Phone: (208) 302-2400
Get Directions

Johnny Bert Green, MD is a colon rectal surgery in Boise, ID. The provider is a colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease. Johnny Bert Green, MD NPI is 1386612414. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1072 N LIBERTY STREET
SUITE 201
BOISE, ID
ZIP 83704
Phone: (208) 302-2400
Fax: (208) 302-2455

The enumeration date for this NPI number is 3/14/2006 and was last updated on 11/15/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	208600000X	Surgery	35113	WASHINGTON	No
2	208C00000X	Colon & Rectal Surgery	35113	WASHINGTON	No
3	208C00000X	Colon & Rectal Surgery	M-11186	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1386612414	MEDICAID	IDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »