# DEMETRIS ALLEN GREEN MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669609459
- **Authorized official:** DR. DEMETRIS ALLEN GREEN SR. MD (PHYSICIAN)
- **Authorized official phone:** (713) 383-9003

## Contact information

- **Practice address:** 10610 FONDREN RD, STE 124, HOUSTON, TX 77096-5422
- **Practice address phone:** (713) 981-5167
- **Practice address fax:** (713) 981-5553
- **Mailing address:** 8299 CAMBRIDGE ST APT 1203, HOUSTON, TX 77054-3141
- **Mailing address phone:** (713) 383-9003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | J4168 | TX | Yes |

## Other

- **Enumeration date:** 06/18/2009
- **Last updated:** 06/22/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 613884700 | US DEPARTMENT OF LABOR | TX |