Healthcare Provider Details

I. General information

NPI: 1114456225
Provider Name (Legal Business Name): JUSTIN L CURTIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/21/2022
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 ESCALANTE DR SUITE 201
DURANGO CO
81303
US

IV. Provider business mailing address

730 W MARKET ST
LIMA OH
45801-4602
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-5303
  • Fax: 970-259-3510
Mailing address:
  • Phone: 419-996-5559
  • Fax: 419-226-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD437
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.003924
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD.0000861
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: