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General NPI Number Information
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NPI Number | 1710900352
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Entity Type | Individual
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Provider Name | MARK STEPHEN JUSTUS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 533 S 336TH ST SUITE C
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6329
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Country | US
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Telephone | 253-661-1700
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Fax | 253-661-4565
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Provider Business Mailing Address
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Address Line | 533 S 336TH ST SUITE C
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6329
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Country | US
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Telephone | 253-661-1700
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Fax | 253-661-4565
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD00046833
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036-103064
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License Number State | IL
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