Green, Jacob T
Green, Jacob T is an individual health care provider with primary practice located at 6750 E Baywood Ave 301, Mesa AZ 85206-1749. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Interventional Cardiology. Allopathic & Osteopathic Physicians / Interventional Cardiology is his primary health care specialty. Green, Jacob T can be contacted via phone (480) 835-6100.Contact Information
Primary practice address
6750 E Baywood Ave 301
Mesa AZ 85206-1749
Phone: (480) 835-6100
Fax: (480) 505-5295
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 054383 | Georgia |
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 41389 | Arizona |
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X | 41389 | Arizona |
Profile Details
| NPI number | 1932384773 |
|---|---|
| LBN Legal business name | Green, Jacob T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 28th, 2007 |
| Last updated | Jun 8th, 2016 - about 8 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 | 1932384773 | NPPES |
| Arizona | MEDICAID | 424562 |
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