Provider Demographics
NPI:1801084181
Name:RUFUS GREEN MD PA
Entity type:Organization
Organization Name:RUFUS GREEN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-243-3368
Mailing Address - Street 1:9 MEDICAL PKWY
Mailing Address - Street 2:PLAZA 4 STE 307
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7855
Mailing Address - Country:US
Mailing Address - Phone:972-243-3368
Mailing Address - Fax:972-243-5296
Practice Address - Street 1:9 MEDICAL PKWY
Practice Address - Street 2:PLAZA 4 307
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7855
Practice Address - Country:US
Practice Address - Phone:972-243-3368
Practice Address - Fax:972-243-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5889174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCH4009OtherRAILROAD MEDICARE
TX033719801Medicaid
TX00059TMedicare PIN
TX033719801Medicaid
TXC04160Medicare UPIN