Provider Demographics
NPI:1316139215
Name:GREEN, JOHN FREDRICK (NP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FREDRICK
Last Name:GREEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREENWAY PLZ STE 2950
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0924
Mailing Address - Country:US
Mailing Address - Phone:713-935-0333
Mailing Address - Fax:
Practice Address - Street 1:10919 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1667
Practice Address - Country:US
Practice Address - Phone:281-251-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L7705Medicare PIN
TX8L7703Medicare PIN
TX8F6847Medicare PIN
TX8L7704Medicare PIN
TX8L7702Medicare PIN