Provider Demographics
NPI:1861522328
Name:GREEN, ROBERT HYMAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HYMAN
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:895 DOVE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2941
Mailing Address - Country:US
Mailing Address - Phone:562-299-8011
Mailing Address - Fax:949-229-8458
Practice Address - Street 1:895 DOVE ST FL 3
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2941
Practice Address - Country:US
Practice Address - Phone:949-229-8447
Practice Address - Fax:949-229-8458
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG366582084P2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A46760Medicare UPIN