Provider Demographics
NPI:1780172098
Name:GREEN, ALLISON MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MICHELLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MICHELLE
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4427 DALNY ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2308
Mailing Address - Country:US
Mailing Address - Phone:214-542-3713
Mailing Address - Fax:
Practice Address - Street 1:712 N WASHINGTON AVE STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1631
Practice Address - Country:US
Practice Address - Phone:214-515-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT5575207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program