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1407001787
TYSON ELLIS GREEN
LAKE CHARLES, LA
NPI
1407001787
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
213ES0103X Podiatrist, Foot & Ankle Surgery
(Licence: LA DPM200024)
Enumeration Date
2008-11-30
Last Update Date
2017-01-30
Business Address
Dr. TYSON ELLIS GREEN D.P.M.
1747 IMPERIAL BLVD
LAKE CHARLES, LA 70605-5362
Phone number: 337-721-7236
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Mailing Address
Dr. TYSON ELLIS GREEN D.P.M.
501 DR MICHAEL DEBAKEY DR
LAKE CHARLES, LA 70601-5724
Phone number: 337-312-8258
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