NPI 1407001787

Tyson Ellis Green, DPM

Practitioner Foot & Ankle Surgery Podiatrist Lake Charles, LA

Practice location

Address: 1747 Imperial Blvd, Lake Charles, LA 70605-5362
Phone: (337) 721-7236
Fax: (337) 721-7237
Mailing address: 501 Dr Michael Debakey Dr, Lake Charles, LA 70601-5724

Registered specialties

Foot & Ankle Surgery Podiatrist Primary

Podiatric Medicine & Surgery Service Providers Taxonomy 213ES0103X Licence DPM200024 (LA)

Other Podiatrist providers in Louisiana →

Registry record

NPI: 1407001787
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Nov 2008
Record last updated: 30 Jan 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.