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Organization
GREEN COUNTRY INFECTIOUS DISEASE PC
Active
Organization
GREEN COUNTRY INFECTIOUS DISEASE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE L BRACKEN (CREDENTIALING)
(918) 448-6160
Entity
Organization
Contact information
Practice address
421 STONE WOOD DR, BROKEN ARROW, OK 74012-1026
(918) 872-8822
Mailing address
5908 S 298TH EAST AVE, BROKEN ARROW, OK 74014-8405
(918) 872-8822
(918) 872-8823
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
NULL
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Enumeration date
03/20/2019
Last updated
04/03/2019
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