Individual
DR. AMANDA RUTH GORDEN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
395200 W 2900 RD, OCHELATA, OK 74051-2463
(918) 535-6000
(918) 535-2694
Mailing address
395200 W 2900 RD, OCHELATA, OK 74051-2463
(918) 535-6000
(918) 535-2694
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4906
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200348650 A
—
OK
Enumeration date
09/29/2009
Last updated
05/04/2022
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