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General NPI Number Information
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NPI Number | 1710481536
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Entity Type | Individual
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Provider Name | JUSTIN LEE OCKSRIDER MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-1315
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Fax |
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Provider Business Mailing Address
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Address Line | 11511 SHADOW CREEK PKWY
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City | PEARLAND
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State | TX
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Zip | 77584-7298
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Country | US
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Telephone | 713-442-0000
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | V0085
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | V0085
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 95451
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License Number State | GA
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