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General NPI Number Information
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NPI Number | 1477558708
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Entity Type | Individual
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Provider Name | KEITH MYRON JUSTICE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2460 OLD MOULTRIE RD STE 4
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4198
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Country | US
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Telephone | 904-563-1482
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Fax |
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Provider Business Mailing Address
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Address Line | 2460 OLD MOULTRIE RD STE 4
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4198
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Country | US
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Telephone | 904-563-1482
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Fax |
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME 75770
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License Number State | FL
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