Individual
DR. MICHAEL LEWIS GREEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 JEROME ST, SUITE 204, FORT WORTH, TX 76104-3945
(817) 720-9552
(817) 921-1830
Mailing address
900 JEROME ST, SUITE 204, FORT WORTH, TX 76104-3945
(817) 720-9552
(817) 921-1830
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
L7736
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163670602
—
TX
05
—
163670603
—
TX
01
—
8S2322
BCBS
TX
Enumeration date
06/22/2006
Last updated
01/28/2022
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