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General NPI Number Information
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NPI Number | 1356631584
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Entity Type | Individual
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Provider Name | JUSTIN STUART HIS
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Gender | Male
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 5737 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-4216
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Country | US
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Telephone | 318-219-4155
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Fax | 318-861-1880
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Provider Business Mailing Address
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Address Line | 5750 JOHNSTON ST STE 502
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City | LAFAYETTE
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State | LA
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Zip | 70503-5334
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Country | US
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Telephone | 318-219-4155
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Fax | 318-861-1880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 1173
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License Number State | LA
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