Individual
TIMOTHY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1020 LENAPE DR, NOWATA, OK 74048
(918) 273-0192
(918) 273-0194
Mailing address
1020 LENAPE DR, NOWATA, OK 74048-4403
(918) 273-0192
(918) 273-0194
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31695
OK
Other
Enumeration date
05/14/2015
Last updated
09/18/2018
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