DR. FRED C GREEN (NPI# 1154330413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154330413 |
| Entity Type | Individual |
| Full Name | DR. FRED C GREEN |
| Credential | DO |
| Practice Address |
2101 Elm St N Fargo ND 58102-2417 |
| Practice Telephone | 7012323241 |
| Mailing Telephone | 7012323241 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01357 | IA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265841225 | Fred Green | Counselor | 10373 Ne Hancock St, Portland, OR 97220-3873 | 2014-08-04 |
| 1679500797 | Fred Green | Nurse Anesthetist, Certified Registered | 3510 N Causeway Blvd, Metairie, LA 70002-3531 | 2006-06-26 |
| Street Address |
2101 ELM ST N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-2417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437143427 | Adam John Glazier | Internal Medicine | 2101 Elm St N, Fargo, ND 58102-2417 | 2005-09-06 |
| 1235740705 | Macy Jane Schindler | Occupational Therapist | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-08-10 |
| 1497363154 | Isaac Nies | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-07-20 |
| 1376151597 | Paul Afanasi Polanski | Social Worker | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-07-14 |
| 1144848763 | Alexis Kokett | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-07-09 |
| 1598396459 | Leah Roethel | Dietitian, Registered | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-01-30 |
| 1619508678 | Allison Wanner | Dietitian, Registered | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-01-29 |
| 1720622822 | Nicole Marie Justice | Psychologist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-10-31 |
| 1750923033 | Samantha J. Tupy | Psychologist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-10-08 |
| 1639723232 | Madelyn Provost | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-07-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679068035 | Rory Ratzlaff | Family Medicine | Sanford Health 737 Broadway N, Fargo, ND 58122-0001 | 2018-06-28 |
| 1710472725 | Shabnum Gupta | Family Medicine | Sanford Health 801 Broadway North, Fargo, ND 58122-0170 | 2018-06-22 |
| 1538661384 | Community Uplift Program | Family Medicine | 417 Main Ave Ste 401, Fargo, ND 58103-1956 | 2018-03-07 |
| 1841576279 | Michelle Vonrueden | Family Medicine | 1018 18th St S, Fargo, ND 58103-2926 | 2011-10-31 |
| 1801174768 | Vidya Vijayaraghavan | Family Medicine | 4689 38th Ave S, Fargo, ND 58104-8506 | 2011-07-26 |
| 1275762924 | Sreejith Gopi | Family Medicine | 4110 51st Avenue South, Fargo, ND 58104 | 2009-07-02 |
| 1356537781 | Terry L Wolff | Family Medicine | 2700 12th Ave Sw, Suite D, Fargo, ND 58103 | 2007-09-19 |
| 1144436338 | Daniel Wilfred Herold | Family Medicine | 225 4th Ave N, Fargo Meps, Fargo, ND 58102-4841 | 2007-05-15 |
| 1679619860 | Carl John Fedyszyn, M.d.,p.c. | Family Medicine | 4550 47th St S Apt 102, Fargo, ND 58104-4360 | 2007-01-29 |
| 1417040189 | Michelle M Radke | Family Medicine | 1711 Gold Drive South Suite 160, Fargo, ND 58103 | 2006-10-02 |
| Find all providers in FARGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.