MEDICARE: MR. JOHN FREDRICK GREEN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	686477	TX

General Provider Information

NPI Number	:	1316139215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN FREDRICK GREEN NP

Provider Business Mailing Address
First Line	:	9 GREENWAY PLZ STE 2950
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77046-0924
Country	:	US
Telephone Number	:	713-935-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	10919 LOUETTA RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1667
Country	:	US
Telephone Number	:	281-251-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	03/16/2009

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