Johnny Bert Green, MD is a
Colon & Rectal Surgery physician based in Boise, Idaho. Johnny Bert Green is licensed to practice in Idaho (license number M-11186) and his current practice location is 1072 N Liberty Street, Suite 201, Boise, Idaho. He can be reached at his office (for appointments etc.) via phone at
(208) 302-2400.
NPI number for Johnny Bert Green is 1386612414 and his current mailing address is 3340 E Goldstone Way, Meridian, Idaho. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1386612414.
Physician's Profile
| Full Name | Johnny Bert Green |
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| Gender | Male |
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| Speciality | Colon & Rectal Surgery |
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| Location | 1072 N Liberty Street, Boise, Idaho |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1386612414
- Provider Enumeration Date: 03/14/2006
- Last Update Date: 11/15/2016
Medical Identifiers
Medical identifiers for Johnny Bert Green such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1386612414 | NPI | - | NPPES |
| 1386612414 | Medicaid | ID | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208600000X | Surgery | 35113 (Washington) | Secondary |
| 208C00000X | Colon & Rectal Surgery | 35113 (Washington) | Secondary |
| 208C00000X | Colon & Rectal Surgery | M-11186 (Idaho) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Johnny Bert Green is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Johnny Bert Green, MD
3340 E Goldstone Way,
Meridian, ID 83642-1026
Ph: (208) 302-2400 | Johnny Bert Green, MD
1072 N Liberty Street, Suite 201,
Boise, ID 83704
Ph: (208) 302-2400 |
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