Active NPI
Clarence Peter Green
- Driver
- Beaumont, TX
National Provider Identifier
1669025789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- 19195530
- Practice address
- 2360 S 8TH St
Beaumont, TX 77701-6401 - Phone
- (409) 239-2779
- NPI assigned
- Jul 17, 2019
- Last updated
- Jun 2, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 19195530 | TX | Primary |
Addresses
Primary practice location
2360 S 8TH St
Beaumont, TX 77701-6401
Mailing address
5550 Folsom Dr Apt 221
Beaumont, TX 77706-7252
Phone (409) 333-7069
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19195530 | TX | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748822400000",
"number": "1669025789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5550 FOLSOM DR APT 221",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777067252",
"telephone_number": "409-333-7069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2360 S 8TH ST",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777016401",
"telephone_number": "409-239-2779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "CLARENCE",
"middle_name": "PETER",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-17",
"last_updated": "2025-06-02",
"certification_date": "2025-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "TX",
"license": "19195530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.