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NPI Code Detail

MEDICARE: DAVID LAVERN JUSTIS MD

MEDICARE: DAVID LAVERN JUSTIS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician0101238293VA

General Provider Information

NPI Number : 1053338699
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID LAVERN JUSTIS MD
Provider Business Mailing Address
First Line : 856 J CLYDE MORRIS BLVD
Second Line : SUITE A
City : NEWPORT NEWS
State : VA
Zip : 23601-1318
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2246 GEORGE WASHINGTON MEMORIAL HWY
Second Line :
City : HAYES
State : VA
Zip : 23072-3559
Country : US
Telephone Number : 804-684-5565
Fax Number : 804-684-5863
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 01/06/2014

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