Green, Kevin Dwight

Green, Kevin Dwight is an individual health care provider with primary practice located at 1720 South Beckham Ave , Tyler TX 75701. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Green, Kevin Dwight can be contacted via phone (903) 595-5101.

Contact Information

Primary practice address
1720 South Beckham Ave Tyler TX 75701
Phone: (903) 595-5101
Fax: (903) 597-2314
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X G5113 Texas

Profile Details

NPI number 1811900194
LBN Legal business name Green, Kevin Dwight
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 15th, 2006
Last updated Jan 10th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811900194 NPPES
Texas Other 75-2616977-008 TRICARE
Texas MEDICAID 129618812 TRICARE
Texas Other 75-2616977-125 TRICARE
Texas MEDICAID 129618808 TRICARE
Texas Other 75-2616977-054 TRICARE
Texas Other 100007934 TRICARE
Texas Other 8GC722 TRICARE

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