Provider Demographics
NPI:1528359254
Name:GREEN, RODDY DEAN (ATP)
Entity Type:Individual
Prefix:
First Name:RODDY
Middle Name:DEAN
Last Name:GREEN
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3374 S TREADAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-6736
Mailing Address - Country:US
Mailing Address - Phone:325-437-3350
Mailing Address - Fax:325-437-3420
Practice Address - Street 1:3374 S TREADAWAY BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-6736
Practice Address - Country:US
Practice Address - Phone:325-437-3350
Practice Address - Fax:325-437-3420
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP 1823247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other