Provider Demographics
NPI:1972550275
Name:GREEN, RUFUS (MD)
Entity type:Individual
Prefix:DR
First Name:RUFUS
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MEDICAL PKWY STE 306
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7855
Mailing Address - Country:US
Mailing Address - Phone:972-888-4063
Mailing Address - Fax:972-888-4039
Practice Address - Street 1:9 MEDICAL PKWY STE 306
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7855
Practice Address - Country:US
Practice Address - Phone:972-888-4063
Practice Address - Fax:972-888-4039
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5889208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033719801Medicaid
TX8147B0Medicare PIN
TX033719801Medicaid