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NPI Code Detail

MEDICARE: ALEXANDRA GREEN DO

MEDICARE: ALEXANDRA GREEN DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
2208600000XSurgery PhysicianW2068TX

General Provider Information

NPI Number : 1295314219
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA GREEN DO
Provider Business Mailing Address
First Line : 1301 PENNSYLVANIA AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2122
Country : US
Telephone Number : 817-250-1501
Fax Number :
Provider Business Practice Location Address
First Line : 1301 PENNSYLVANIA AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2122
Country : US
Telephone Number : 817-250-1501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2021
Last Update Date : 06/22/2026

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