Provider Demographics
NPI:1144431800
Name:GREEN, PATRICK NELSON (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:NELSON
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:134 W 1180 N
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074
Mailing Address - Country:US
Mailing Address - Phone:435-248-0333
Mailing Address - Fax:435-248-0334
Practice Address - Street 1:134 W 1180 N
Practice Address - Street 2:SUITE # 5
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:435-248-0333
Practice Address - Fax:435-248-0334
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6846499-8905207QA0401X
UT6846499-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine