Provider Demographics
NPI:1851337570
Name:GREEN, DONALD ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ROBERT
Last Name:GREEN
Suffix:
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 1:1600 NORTH MAIN
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-2830
Mailing Address - Country:US
Mailing Address - Phone:575-396-6611
Mailing Address - Fax:575-396-1454
Practice Address - Street 1:120 E BEAUREGARD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5919
Practice Address - Country:US
Practice Address - Phone:325-658-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209854-1207L00000X
NMMD2013-0731207L00000X
TXT7575207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0945OtherEXCELLUS BC/BS
NY103217AFOtherPREFERRED CARE
NYP010209854OtherEXCELLUS BLUE CHOICE
NM88879259Medicaid
NYCAN209854-9WOtherWORKERS' COMPENSATION
NY01908685Medicaid
NY01908685Medicaid
NM323853YNGGMedicare Oscar/Certification
NY0945OtherEXCELLUS BC/BS