Ivor Green M.D. a Professional Corporation

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

IVOR GREEN M.D. A PROFESSIONAL CORPORATION

Practice address

438 W Las Tunas Dr
San Gabriel, CA 91776-1216

Phone

(626) 289-5454

Fax

(626) 457-7172

NPI assigned

Aug 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ivor Green, M.D.

Title

President

Phone

(818) 825-9423

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1023027794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 S LAKE AVE",
            "address_2": "535",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911013005",
            "telephone_number": "626-795-6596",
            "fax_number": "626-795-8247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 W LAS TUNAS DR",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917761216",
            "telephone_number": "626-289-5454",
            "fax_number": "626-457-7172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVOR GREEN M.D. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "IVOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-825-9423",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A253490",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A253490",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiology Physician in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.