person
Dr. Tyson Ellis Green, DPM
Foot & Ankle Surgery Podiatrist in Lake Charles, Louisiana
NPI 1407001787

Tyson Ellis Green is a Foot & Ankle Surgery Podiatrist based in Lake Charles, LA and is specialized in Foot & Ankle Surgery. Tyson Ellis Green practices in Lake Charles, LA and has the professional credentials of DPM. The NPI Number for Tyson Ellis Green is 1407001787 and holds a License No. DPM200024 (Louisiana).

The current practice location address for Tyson Ellis Green is 1747 Imperial Blvd, Lake Charles, LA and can be reached out via phone at 337-721-7236 and via fax at 337-721-7237. You can also correspond with Tyson Ellis Green through the mailing address at 501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA - 70601-5724 (mailing address contact number: 337-312-8258).

Location: 1747 Imperial Blvd, Lake Charles, LA, 70601-5724
person
Provider Profile Details
NPI Number
1407001787
Provider Name
Tyson Ellis Green
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
1747 Imperial Blvd, Lake Charles, LA, 70601-5724
Phone Number
337-721-7236
Fax Number
337-721-7237
Provider Enumeration Date
11/30/2008
Last Update Date
03/09/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
1805033 05 LA
institution
Provider Business Practice Location Address Details
Address
1747 Imperial Blvd
City
State
Zip
70605-5362
Phone Number
337-721-7236
Fax Number
337-721-7237
person
Provider Business Mailing Address Details
Address
501 Dr Michael Debakey Dr
City
State
Zip
70601-5724
Phone Number
337-312-8258
Fax Number
337-312-6711
person
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot & Ankle Surgery
Taxonomy
License No.
DPM200024 (Louisiana)
Definition
Definition to come...
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