Individual
LARA E GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2821 36TH AVE NW STE 105, NORMAN, OK 73072-2471
(405) 515-2049
(405) 307-5631
Mailing address
PO BOX 1330, NORMAN, OK 73070-1330
(405) 307-6668
(405) 701-6170
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1235
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200063470A
—
OK
Enumeration date
03/09/2006
Last updated
07/28/2021
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