MEDICARE: DR. DAVID PHILLIP GREEN M.D.

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	207RP1001X	Pulmonary Disease Physician	92-63	NM

General Provider Information

NPI Number	:	1295813202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PHILLIP GREEN M.D.

Provider Business Mailing Address
First Line	:	12901 CALLE DE SANDIAS NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2922
Country	:	US
Telephone Number	:	505-299-2660
Fax Number	:

Provider Business Practice Location Address
First Line	:	3121 AMHERST DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4807
Country	:	US
Telephone Number	:	505-841-5738
Fax Number	:	505-841-5657

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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