Individual
JAYLEN Z GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19600 E ROSS ST, TAHLEQUAH, OK 74464-0545
(539) 234-1000
Mailing address
19600 E ROSS ST, TAHLEQUAH, OK 74464-0545
(539) 234-1000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
38136
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2018
Last updated
08/24/2021
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