Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | Q8494 | TX |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | Q8494 | TX |
NPI | 1184709917 |
---|---|
Provider Name | John Robert Green III |
First Address | San Antonio, TX 78229-3931 |
Second Address | San Antonio, TX 78229-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 23/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0231188 | L&I (01) | WA |
1184709917 | (05) | WA |
292620 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
361623701 | (05) | TX |
361623702 | CSHCN (01) | TX |
513724YK00 | (02) | TX |
G32870 | (02) |