Provider Demographics
NPI:1932319803
Name:GREENE, JOSHUA HUNTER (OPA-C, LSA)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:HUNTER
Last Name:GREENE
Suffix:
Gender:M
Credentials:OPA-C, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 ARROWHEAD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6545
Mailing Address - Country:US
Mailing Address - Phone:903-826-3302
Mailing Address - Fax:
Practice Address - Street 1:4803 ARROWHEAD LAKE DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6545
Practice Address - Country:US
Practice Address - Phone:903-826-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0013132255A2300X
363AS0400X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1077OtherSTATE LICENSE
TXSA00536OtherTEXAS STATE SURGICAL ASSISTANT LICENSE