Provider Demographics
NPI:1760456123
Name:GREEN, RICHARD NEAL SR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NEAL
Last Name:GREEN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HOSPITAL DR STE 111
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2489
Mailing Address - Country:US
Mailing Address - Phone:903-641-4895
Mailing Address - Fax:903-641-4894
Practice Address - Street 1:400 HOSPITAL DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2489
Practice Address - Country:US
Practice Address - Phone:903-641-4835
Practice Address - Fax:903-641-4846
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8242207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100626403Medicaid
TX100626404Medicaid
TX8CA699OtherBLUE CROSS
TX100626403Medicaid
TX8CA699OtherBLUE CROSS
TX8L15069Medicare PIN
TX100626404Medicaid