Provider Demographics
NPI:1144667924
Name:GREEN, DONALD WAYNE (DVM)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WAYNE
Last Name:GREEN
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-9203
Mailing Address - Country:US
Mailing Address - Phone:270-524-0301
Mailing Address - Fax:270-524-1145
Practice Address - Street 1:805 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9203
Practice Address - Country:US
Practice Address - Phone:270-524-0301
Practice Address - Fax:270-524-1145
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYNS-KY-1398174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian