Provider Demographics
NPI:1780742528
Name:GREEN, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6600 SOUTH YALE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-488-6010
Practice Address - Street 1:1401 EAST VAN BUREN AVENUE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-426-0240
Practice Address - Fax:918-423-4051
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-09-22
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Provider Licenses
StateLicense IDTaxonomies
AL26043207R00000X
OK26629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200215670AMedicaid
AL009962015Medicaid
OK200215670AMedicaid
ALI16685Medicare UPIN