Healthcare Provider Details

I. General information

NPI: 1215511407
Provider Name (Legal Business Name): JOHN ADAM GREEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E RIDGE RD STE 204
MCALLEN TX
78503-1251
US

IV. Provider business mailing address

13037 SW 95TH AVE
MIAMI FL
33176-5728
US

V. Phone/Fax

Practice location:
  • Phone: 956-632-6020
  • Fax:
Mailing address:
  • Phone: 321-720-4658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9462851
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11026464
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11026464
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1129335
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: