Provider Demographics
NPI:1508157371
Name:GREEN, ALISON LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:LOUISE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:LOUISE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 MCLAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3550
Mailing Address - Country:US
Mailing Address - Phone:870-523-0193
Mailing Address - Fax:978-525-2342
Practice Address - Street 1:1200 MCLAIN ST STE G
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3550
Practice Address - Country:US
Practice Address - Phone:870-523-0193
Practice Address - Fax:978-525-2342
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7874207Q00000X
MA266537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205352001Medicaid