Individual
MATTHEW S GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 525-1914
(903) 525-1930
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP132253
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
369843301
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
8073MB
BCBS
TX
01
—
P01787482
RAIL ROAD MEDICARE
TX
Enumeration date
11/30/2016
Last updated
06/09/2017
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