Individual provider · NPI-1

Tanisha Green, MD

General Practice · Richmond, TX

NPI number1174616478
StatusActive
Last updated in NPPESAug 2, 2021

Details

NPI
1174616478
Entity type
Individual (NPI-1)
Name
Tanisha Green
Credential
MD
Sex
Female
Sole proprietor
No
Enumeration date
Oct 2, 2006
Certification date
Aug 2, 2021
Last updated
Aug 2, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208D00000X General PracticeM1117TXYes
207L00000X AnesthesiologyM1117TX

Practice location

12111 San Luca St
Richmond, TX 77406-1542

Phone 713-882-7223

Mailing address

Po Box 840853
Dallas, TX 75284-0863

Phone 713-620-4000

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