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Individual

DR. JUSTIN B. GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
2309 E MAIN ST, SUITE 201, NEW IBERIA, LA 70560-4046
(337) 364-8878
(337) 364-8380
Mailing address
2309 E MAIN ST, SUITE 201, NEW IBERIA, LA 70560-4046
(337) 560-5543

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PD324R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1462462
LA
01
2223526
FIRST HEALTH
LA
01
7714575
AETNA
LA
01
PD324R
STATE LICENSE #
LA
Enumeration date
07/18/2005
Last updated
07/08/2007
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