Provider Demographics
NPI:1386433670
Name:GREEN, BRANDON ANDRES
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ANDRES
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 S BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1200
Mailing Address - Country:US
Mailing Address - Phone:918-808-5872
Mailing Address - Fax:
Practice Address - Street 1:4328 S BEECH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1200
Practice Address - Country:US
Practice Address - Phone:918-808-5872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator