Provider Demographics
NPI:1730375791
Name:GREEN, RYAN BRADLEY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BRADLEY
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 N CALIFORNIA BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-7164
Mailing Address - Country:US
Mailing Address - Phone:925-543-0140
Mailing Address - Fax:925-543-0145
Practice Address - Street 1:2175 N CALIFORNIA BLVD STE 425
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-7164
Practice Address - Country:US
Practice Address - Phone:925-543-0140
Practice Address - Fax:925-543-0145
Is Sole Proprietor?:No
Enumeration Date:2007-09-23
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92082207L00000X
AZ40159207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92082OtherCA STATE MEDICAL BOARD