Stanley W Green, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

163990-1205 Issued in UT

Practice address

55 E 100 S
Salem, UT 84653-8214

Phone

(801) 423-2310

NPI assigned

Sep 26, 2005

Last updated

Jul 13, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD (past)

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1184610065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 W 1800 N",
            "address_2": "PMB 305",
            "city": "CLINTON",
            "state": "UT",
            "postal_code": "840157923",
            "telephone_number": "801-310-0153",
            "fax_number": "801-776-3957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 E 100 S",
            "city": "SALEM",
            "state": "UT",
            "postal_code": "846538214",
            "telephone_number": "801-423-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "STANLEY",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "UT",
            "license": "163990-1205",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "163990-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Connor Gessel, NP
• Zachary Gibson, PA
• Sara Gleaves, PT, DPT
• Alana Gordon, MFTI, CCPS
• Monique Celeste Gravley, PTA
• Seth M Grisham, PA-C
• Robert Jeremy Guenter, D.D.S.
• Zachary Jon Haag, DO
• Jerry Antony Hadlock, CRNA
• Ruth Haleen

• Diagnostic Radiology Physician in Salem, UT
• Providers in Salem, UT by specialty
• Diagnostic Radiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; 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.