| NPI | 1396210563 |
|---|---|
| Doing Business As | GREEN SPORTS MEDICINE, INC. |
| Entity Type | Organization |
| Authorized Contact | ERICK GREEN Md 559-813-3005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2019-11-18 |