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NPI Code Detail

MEDICARE: JUSTIN FAMOSO MD

MEDICARE: JUSTIN FAMOSO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician51553AZ

General Provider Information

NPI Number : 1396155461
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN FAMOSO MD
Provider Business Mailing Address
First Line : PO BOX 749495
Second Line :
City : ATLANTA
State : GA
Zip : 30374-9495
Country : US
Telephone Number : 855-963-2100
Fax Number : 813-321-1296
Provider Business Practice Location Address
First Line : 1281 E COTTONWOOD LN
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85122-2949
Country : US
Telephone Number : 520-836-9800
Fax Number : 520-836-1510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2014
Last Update Date : 03/09/2026

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Directions to “ JUSTIN FAMOSO MD” Practice Location

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