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General NPI Number Information
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NPI Number | 1821988866
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Entity Type | Individual
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Provider Name | JUSTIN COLE DRUSKIS PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 1235 12TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-1578
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Country | US
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Telephone | 580-222-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 17311 BONASILA CIR
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City | EAGLE RIVER
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State | AK
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Zip | 99577-8119
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Country | US
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Telephone | 402-378-2887
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 236746
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License Number State | AK
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