MEDICARE: FOOT & ANKLE SURGEONS OF OKLAHOMA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	290	OK

General Provider Information

NPI Number	:	1962747444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT & ANKLE SURGEONS OF OKLAHOMA PLLC

Provider Business Mailing Address
First Line	:	PO BOX 268996
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8996
Country	:	US
Telephone Number	:	405-418-4500
Fax Number	:	405-418-4501

Provider Business Practice Location Address
First Line	:	4221 S WESTERN AVE
Second Line	:	#4020
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3447
Country	:	US
Telephone Number	:	405-418-4500
Fax Number	:	405-418-4501

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER J. GREEN
Credential	:	DPM
Telephone Number	:	405-418-4500

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	03/17/2018

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