Individual
DR. DEMETRIS ALLEN GREEN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2646 S LOOP W, SUITE 440, HOUSTON, TX 77054-2665
(713) 808-9658
(281) 501-3075
Mailing address
2646 S LOOP W, SUITE 440, HOUSTON, TX 77054-2665
(713) 808-9658
(281) 501-3075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
J4168
TX
208D00000X
General Practice Physician
Primary
J4168
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2817272
—
TX
Enumeration date
07/03/2007
Last updated
08/05/2012
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