Green, Derek A
Green, Derek A is an individual health care provider with primary practice located at 330 Ne Marshall Ave , Bend OR 97701-4346. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic, which is considered as his primary health care specialty. Green, Derek A can be contacted via phone (541) 383-8179.Contact Information
Primary practice address
330 Ne Marshall Ave
Bend OR 97701-4346
Phone: (541) 383-8179
Fax: (541) 382-2879
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic | 2251X0800X | 6254 | Oregon |
Profile Details
| NPI number | 1285946822 |
|---|---|
| LBN Legal business name | Green, Derek A |
| Credentials | DPT |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2010 |
| Last updated | May 6th, 2014 - about 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285946822 | NPPES |
| Oregon | MEDICAID | 500652855 |
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