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General NPI Number Information
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NPI Number | 1457819146
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Entity Type | Individual
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Provider Name | JUSTIN T JUELICH PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 6445 MAIN ST STE 2500
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City | HOUSTON
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State | TX
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Zip | 77030-1502
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Country | US
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Telephone | 713-441-9000
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Fax | 713-790-7500
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Provider Business Mailing Address
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Address Line | 6445 MAIN ST STE 2500
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City | HOUSTON
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State | TX
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Zip | 77030-1502
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Country | US
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Telephone | 713-441-9000
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Fax | 713-790-7500
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA14854
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA14854
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1417
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9111679
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License Number State | FL
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