Organization
GREEN MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE CHARLES GREEN M.D. (OWNER)
(918) 456-8989
Entity
Organization
Contact information
Practice address
23507 EAST RIVERVIEW DRIVE, COOKSON, OK 74427
(918) 456-8989
(918) 456-7989
Mailing address
1 PLAZA SOUTH ST, TAHLEQUAH, OK 74464-4750
(918) 456-8989
(918) 456-7989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9260
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100093200D
—
OK
01
—
D05217
UPIN
OK
Enumeration date
07/26/2007
Last updated
11/01/2012
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