Green, Mitra Marie
Green, Mitra Marie is an individual health care provider with primary practice located at 3421 Medical Park Dr , Monroe LA 71203-2355. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Green, Mitra Marie can be contacted via phone (318) 376-7337.Contact Information
Primary practice address
3421 Medical Park Dr
Monroe LA 71203-2355
Phone: (318) 376-7337
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 020108 | Louisiana |
Profile Details
| NPI number | 1699702761 |
|---|---|
| LBN Legal business name | Green, Mitra Marie |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 26th, 2006 |
| Last updated | Apr 11th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699702761 | NPPES |
| Louisiana | MEDICAID | 1950831 |
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