=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346333572
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN FRANCIS JUSTICE D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 06/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2305 GEORGIA
-----------------------------------------------------
City | LOUISIANA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-754-4584
-----------------------------------------------------
Fax | 573-754-5280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2305 GEORGIA STREET
-----------------------------------------------------
City | LOUISIANA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-754-4584
-----------------------------------------------------
Fax | 573-754-5280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | RIE27
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | R1E27
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------