| Doctor Name: | DR. JUSTIN B. GREEN |
| NPI Number: | 1124027644 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | PD324R |
| Business Practice Address: | 2309 E Main St Suite 201 New Iberia, LA - 705604046 |
| Business Phone Number: | 3373648878 |
| Business Fax Number: | 3373648380 |
| Mailing Address: | 2309 E Main St, Suite 201 NEW IBERIA |
| State: | LA |
| Postal Code: | 705604046 |
| Phone Number: | 3375605543 |
| Fax Number: | |
| NPI Enumeration Date: | 07/18/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | PD324R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |