Provider Demographics
NPI:1982659207
Name:GREEN, DEANN MILLER (MD)
Entity Type:Individual
Prefix:MRS
First Name:DEANN
Middle Name:MILLER
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DEANN
Other - Middle Name:M
Other - Last Name:DIPIAZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:701 UNIVERSITY BLVD. EAST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401
Mailing Address - Country:US
Mailing Address - Phone:205-349-4131
Mailing Address - Fax:205-759-2569
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 502
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-349-4131
Practice Address - Fax:205-759-2569
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25654174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-33141OtherBCBS PROVIDER #
AL528600770Medicaid
AL528600770Medicaid