Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | BP10050867 | TX |
Y | 2080P0204X | Pediatric Emergency Doctor | 6171 | OK |
NPI | 1093129686 |
---|---|
Provider Name | Daniel Green |
First Address | Oklahoma City, OK 73104-5008 |
Second Address | Oklahoma City, OK 73104-5008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2014 |
Last Update Date | 17/03/2018 |