PETER GREEN MD PA
Ambulatory Health at South Fwy, Burleson, TX

License number
Texas F8497
Category
Ambulatory Health
Type
Primary Care
Owner
Name: DR. PETER GREEN MD
Title: MD
Phone: (817) 293-2944
Address
Address 2
11801 South Fwy SOUTH SUITE 234, Burleson, TX 76028
PO Box 6337, Fort Worth, TX 76115
National Provider ID: 1891004420
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PETER GREEN, M.D., PA

Fort Worth, TX

Status:
Inactive
Registration:
Nov 29, 1995
Addresses:
4429 Bombay Ct, Fort Worth, TX 76116 (Mailing)
11797 S Fwy, Fort Worth, TX 76115
State ID:
0081666603
Business type:
Professional Association
President , Treasurer , Secretary , Director , Member , Vice-President:
Peter C. Green (President , Treasurer , Secretary , Director , Member , Vice-President)
Agent:
Peter Calder Green,11797 S Fwy STE 234, Fort Worth, TX 76115 (Physical)
TIN:
32036015421

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