Green, Roddy D
Green, Roddy D is an individual health care provider with primary practice located at 100 Bourland Rd Ste 100 , Keller TX 76248-3591. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Green, Roddy D can be contacted via phone (817) 379-5100.Contact Information
Primary practice address
100 Bourland Rd Ste 100
Keller TX 76248-3591
Phone: (817) 379-5100
Fax: (817) 379-0479
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | L6054 | Texas |
Profile Details
| NPI number | 1801821780 |
|---|---|
| LBN Legal business name | Green, Roddy D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 11th, 2006 |
| Last updated | Feb 23rd, 2022 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1801821780 | NPPES |
| Texas | MEDICAID | 170258105 | |
| Texas | MEDICAID | 170258101 | |
| Texas | MEDICAID | 170258102 |
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