Basic Information
| Provider Information | |||||||||
| NPI: | 1821371022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | ERICK | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7471 N FRESNO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937202457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594364500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2021 HERNDON AVE # 101 | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597974315 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2011 | ||||||||
| LastUpdateDate: | 03/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A130378 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | A130378 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.