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Dr. Justin B. Green

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NPI Number Detailed Information

Provider Information:

Name: Dr. Justin B. Green
Gender: M
Provider License Number If Given: PD324R

NPI Information:

NPI: 1124027644
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 2309 E MAIN ST SUITE 201
New Iberia, LA 70560
Phone Number: 3375605543
Fax Number:

Provider Business Practice Location Address:

Address: 2309 E MAIN ST SUITE 201
New Iberia, LA 70560
Phone Number: 3373648878
Fax Number: 3373648380

Provider Taxonomy:

Primary: 213ES0103X
Secondary (if any):
State: LA

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