Phil James Green PAC

NPI 1083610752 - Family Medicine - 207Q00000X

NPI Details
NPI 1083610752
Gender Male
Enumeration Date 06/27/2005
Last Updated 07/08/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
1009 W FERGUSON AVE
BLACKWELL OK, 74631-5602, US
Phone (580) 363-0052
Fax (580) 363-0894
Business Location
1009 W FERGUSON AVE
BLACKWELL OK, 74631-5602, US
Phone (580) 363-0052
Fax (580) 363-0894
Toxanomy
Taxonomy Code 207Q00000X
License State Oklahoma
License Number PA800
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According to our database, Phil James Green PAC NPI is 1083610752, taxonomy code is 207Q00000X and license number is PA800, license state is located at Oklahoma. Phil James Green PAC physically located at 1009 W Ferguson Ave, Blackwell OK, 74631-5602. NPI Number Phil James Green PAC has the Individual type.

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1083610752 NPI number is provided on an as is basis without warranty of any kind. 1083610752 is maintained by the National Plan & Provider Enumeration System. The contents of Phil James Green PAC are for informational purposes only.