Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | H8662 | TX |
NPI | 1093777898 |
---|---|
Provider Name | David Warner Green |
First Address | Richardson, TX 75082-3569 |
Second Address | Richardson, TX 75082-3569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116750401 | (05) | TX |
B87989 | (02) | TX |
H8662 | TEXAS LICENSE (01) | TX |