Provider Demographics
NPI:1699507756
Name:GREEN TREE FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:GREEN TREE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEGAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GABBIDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-941-3399
Mailing Address - Street 1:1411 N FLAGLER DR STE 9300B
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-941-3399
Mailing Address - Fax:561-941-3398
Practice Address - Street 1:1411 N FLAGLER DR STE 9300B
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-941-3399
Practice Address - Fax:561-941-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty