Physician Compare National (NPI:1699973420)

HEALTHCARE PROVIDER: DEMETRIS ALLEN GREEN SR. MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1699973420
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618026170
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090513000222
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GREEN
	Individual professional last name
Provider First Name	DEMETRIS
	Individual professional first name
Provider Middle Name	A.
	Individual professional middle name
Provider Name Suffix Text	SR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	BAYLOR COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2646 S LOOP W
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 220
	Group Practice or individual's line 2 address
City	HOUSTON
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	770542640
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7138089658
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y