MEDICARE: ANDREA LYNETTE WHITE 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	207P00000X	Emergency Medicine Physician	27978	WI
2	207P00000X	Emergency Medicine Physician	43981	CO
3	207P00000X	Emergency Medicine Physician	G9826	TX
4	207P00000X	Emergency Medicine Physician	036153315	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00421202	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477538296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA LYNETTE WHITE GREEN MD

Provider Business Mailing Address
First Line	:	5 TWIN SPRINGS DR
Second Line	:
City	:	DALWORTHINGTON GARDENS
State	:	TX
Zip	:	76016-4027
Country	:	US
Telephone Number	:	817-467-0527
Fax Number	:	817-467-0573

Provider Business Practice Location Address
First Line	:	5 TWIN SPRINGS DR
Second Line	:
City	:	DALWORTHINGTON GARDENS
State	:	TX
Zip	:	76016-4027
Country	:	US
Telephone Number	:	817-467-0527
Fax Number	:	817-467-0573

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	01/03/2025

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