Provider Demographics
NPI:1124139571
Name:GREEN, DAVID LYNN (CRNA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LYNN
Last Name:GREEN
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:4100 INTERNATIONAL PLAZA
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-334-0530
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:1502 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-1734
Practice Address - Country:US
Practice Address - Phone:325-235-4457
Practice Address - Fax:325-235-0170
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX231635207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology