Individual
DR. MARY KELLY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
204 GATEWAY N, SUITE A, MARBLE FALLS, TX 78654-6361
(830) 693-5868
(830) 798-8017
Mailing address
204 GATEWAY N, SUITE A, MARBLE FALLS, TX 78654-6361
(830) 693-5868
(830) 798-8017
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
N1341
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2051849
—
TX
Enumeration date
11/15/2007
Last updated
05/16/2012
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