KEVIN DWIGHT GREEN (NPI# 1811900194) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811900194 |
| Entity Type | Individual |
| Full Name | KEVIN DWIGHT GREEN |
| Credential | M.D. |
| Practice Address |
1720 South Beckham Ave Tyler TX 75701 |
| Mailing Address |
Po Box 846098 Dallas TX 75284-6098 |
| Practice Telephone | 9035955101 |
| Practice Fax Number | 9035972314 |
| Mailing Telephone | 9033246400 |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2017-01-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
G5113 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TRICARE | 75-2616977-054 | 01 |
| TX | 129618808 | 05 | |
| TX | 129618812 | 05 | |
| TX | BCBS | 8GC722 | 01 |
| TX | TRICARE | 75-2616977-125 | 01 |
| TX | RAIL ROAD MEDICARE | 100007934 | 01 |
| TX | TRICARE | 75-2616977-008 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497227151 | Kevin Lee Green | Physician Assistant | 10221 E 81st St, Tulsa, OK 74133-4559 | 2018-12-19 |
| 1003319161 | Kevin Bernard Green | Non-emergency Medical Transport (VAN) | 10217 Woodland Hills Dr, Cordova, TN 38018-6663 | 2018-03-15 |
| 1346602927 | Kevin Roy Green | Internal Medicine | 653-1 W 8th St # L18, Jacksonville, FL 32209-6511 | 2016-03-23 |
| 1801901897 | Kevin Robert Green | Acupuncturist | 1259 W 20th Ave, Oshkosh, WI 54902-6650 | 2006-08-20 |
| 1699770495 | Kevin J Green | Optometrist | 2038 Monument Ave, Richmond, VA 23220-2708 | 2005-06-17 |
| 1649605965 | Kevin M Green | Marriage & Family Therapist | 199 N 290 W, Suite 150, Lindon, UT 84042-1810 | 2013-09-05 |
| 1922237312 | Kevin M Green | Chiropractor | 500 N Financial Ter, Ste G, Mustang, OK 73064-4437 | 2009-07-07 |
| 1114165941 | Kevin Anthony Green IIi | Counselor | 2112 Riverdale Street, West Springfield, MA 01089 | 2009-02-02 |
| 1053521302 | Kevin Joseph Green | Physician Assistant | 1450 Scalp Ave, Suite 106, Johnstown, PA 15904-3374 | 2007-05-23 |
| 1831265628 | Kevin P Green | Social Worker | 2021 Grand Concourse Fl 9, Bronx, NY 10453-4304 | 2006-11-26 |
| Street Address |
1720 SOUTH BECKHAM AVE |
| City | TYLER |
| State | TX |
| Zip Code | 75701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073526604 | George Aaron Duvall | Internal Medicine | 1720 South Beckham Ave, Tyler, TX 75701 | 2006-08-14 |
| 1821001116 | Richard Heston Seidel Jr. | Internal Medicine | 1720 South Beckham Ave, Tyler, TX 75701 | 2006-08-15 |
| 1437162716 | Peter Kevin Meyers | Internal Medicine | 1720 South Beckham Ave, Tyler, TX 75701 | 2006-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053324343 | Craig Michael Radford | Internal Medicine | 1720 South Beckham, Tyler, TX 75701 | 2006-08-15 |
| 1265445886 | L Don Freeman | Internal Medicine | 1720 S Beckham Ave, Tyler, TX 75701 | 2006-08-14 |
| 1073526604 | George Aaron Duvall | Internal Medicine | 1720 South Beckham Ave, Tyler, TX 75701 | 2006-08-14 |
| 1285619205 | Xiaotuan Zhao | Internal Medicine | 910 E Houston St Ste 550, Tyler, TX 75702-8366 | 2005-12-13 |
| 1629061171 | Mark D Prince | Internal Medicine | 910 E Houston St Ste 470, Tyler, TX 75702-8365 | 2005-08-30 |
| 1144632621 | Aligned Providers of East Texas | Internal Medicine | 1783 Troup Hwy, Tyler, TX 75701-5869 | 2014-06-02 |
| 1952557282 | Ebube Mbanu Nwaigwe | Internal Medicine | 11937 Us Highway 271, Tyler, TX 75708-3154 | 2008-08-18 |
| 1982880647 | Elias I Fanous Jr Md Pa | Internal Medicine | 700 Olympic Plaza Cir, Suite 508, Tyler, TX 75701-1951 | 2008-01-11 |
| 1649308842 | Gastroenterology Associates of Tyler Pa | Internal Medicine | 700 Olympic Plaza Cir, 407, Tyler, TX 75701-1951 | 2007-03-01 |
| 1689788838 | Digestive Health Specialists of Tyler | Internal Medicine | 1720 South Beckham, Tyler, TX 75701 | 2006-08-17 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.