JOHNNY BERT GREEN

BOISE, ID
NPI1386612414
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy208C00000X Colon & Rectal Surgery
(Licence: ID  M-11186)
Additional Taxonomies208600000X Surgery
(Licence: WA  35113)
208C00000X Colon & Rectal Surgery
(Licence: WA  35113)
Enumeration Date2006-03-14
Last Update Date2016-11-15
Business Address
-- JOHNNY BERT GREEN MD
1072 N LIBERTY STREET SUITE 201
BOISE, ID 83704
Phone number: 208-302-2400
Mailing Address
-- JOHNNY BERT GREEN MD
3340 E GOLDSTONE WAY
MERIDIAN, ID 83642-1026
Phone number: 208-302-2400
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