Individual
MITRA MARIE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3421 MEDICAL PARK DR, MONROE, LA 71203-2355
(318) 376-7337
Mailing address
1601 LAMY LN, MONROE, LA 71201-3735
(318) 387-3453
(318) 323-9045
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
020108
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1950831
—
LA
Enumeration date
06/26/2006
Last updated
04/11/2023
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