Individual
CASEY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2400
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
N1657
TX
2084P0802X
Addiction Psychiatry Physician
N1657
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215031003
—
TX
01
—
8DM260
BCBS
TX
Enumeration date
11/13/2008
Last updated
04/04/2016
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