Provider Demographics
NPI:1184709917
Name:GREEN, JOHN ROBERT III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:GREEN
Suffix:III
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 1:8300 FLOYD CURL DR FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3931
Mailing Address - Country:US
Mailing Address - Phone:210-450-9300
Mailing Address - Fax:210-450-6023
Practice Address - Street 1:8300 FLOYD CURL DR FL 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9300
Practice Address - Fax:210-450-6023
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8494207X00000X, 207XX0005X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0231188OtherL&I
292620OtherINTERNAL ID-MOTOR VEHICLE ID
TX361623701Medicaid
TX361623702OtherCSHCN
WA1184709917Medicaid
TX513724YK00Medicare UPIN
292620OtherINTERNAL ID-MOTOR VEHICLE ID
G32870Medicare UPIN