MEDICARE: DR. RONALD ALAN GREEN MD

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	207Q00000X	Family Medicine Physician	L6405	TX
2	2083X0100X	Occupational Medicine Physician	L6405	TX

General Provider Information

NPI Number	:	1083784748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD ALAN GREEN MD

Provider Business Mailing Address
First Line	:	5644 WESTHEIMER RD
Second Line	:	SUITE 347
City	:	HOUSTON
State	:	TX
Zip	:	77056-4002
Country	:	US
Telephone Number	:	832-407-2276
Fax Number	:	832-201-6777

Provider Business Practice Location Address
First Line	:	5644 WESTHEIMER RD
Second Line	:	SUITE 347
City	:	HOUSTON
State	:	TX
Zip	:	77056-4002
Country	:	US
Telephone Number	:	832-407-2276
Fax Number	:	832-201-6777

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	03/01/2011

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