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General NPI Number Information
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NPI Number | 1982895181
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Entity Type | Organization
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Legal Business Name | SCOTT C JUSTESEN, MD, PC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 377 N FAIRGROUNDS RD
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City | PRICE
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State | UT
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Zip | 84501-4208
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Country | US
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Telephone | 435-613-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 377 N FAIRGROUNDS RD
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City | PRICE
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State | UT
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Zip | 84501-4208
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Country | US
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Telephone | 435-613-6600
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. SCOTT CHARLES JUSTESEN
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Credential | MD
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Telephone | 435-613-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | PENDING
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License Number State | UT
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