Provider Demographics
NPI:1457447328
Name:WAYNE D GREEN, MD, PA
Entity Type:Organization
Organization Name:WAYNE D GREEN, MD, PA
Other - Org Name:RIO GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIAN
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-423-1050
Mailing Address - Street 1:3101 SOUTH 77 SUNSHINE STRIP
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8904
Mailing Address - Country:US
Mailing Address - Phone:956-423-1050
Mailing Address - Fax:956-423-1585
Practice Address - Street 1:3101 SOUTH 77 SUNSHINE STRIP
Practice Address - Street 2:SUITE A
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8904
Practice Address - Country:US
Practice Address - Phone:956-423-1050
Practice Address - Fax:956-423-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0738207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1734030 01Medicaid
TXG61780Medicare UPIN
TX00698YMedicare PIN