Provider Demographics
NPI:1215156229
Name:GREEN, HUBERT GORDON (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:GORDON
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9082
Mailing Address - Country:US
Mailing Address - Phone:214-648-6579
Mailing Address - Fax:214-648-1505
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9082
Practice Address - Country:US
Practice Address - Phone:214-648-6579
Practice Address - Fax:214-648-1505
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H39879Medicare UPIN