Organization
DEMETRIS ALLEN GREEN MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEMETRIS ALLEN GREEN SR. MD (PHYSICIAN)
(713) 383-9003
Entity
Organization
Contact information
Practice address
10610 FONDREN RD, STE 124, HOUSTON, TX 77096-5422
(713) 981-5167
(713) 981-5553
Mailing address
8299 CAMBRIDGE ST APT 1203, HOUSTON, TX 77054-3141
(713) 383-9003
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
J4168
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
613884700
US DEPARTMENT OF LABOR
TX
Enumeration date
06/18/2009
Last updated
06/22/2009
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