Provider Demographics
NPI:1295813202
Name:GREEN, DAVID PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PHILLIP
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12901 CALLE DE SANDIAS NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2922
Mailing Address - Country:US
Mailing Address - Phone:505-299-2660
Mailing Address - Fax:
Practice Address - Street 1:3121 AMHERST DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4807
Practice Address - Country:US
Practice Address - Phone:505-841-5738
Practice Address - Fax:505-841-5657
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM92-63207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease