MEDICARE: DR. ANTHONY RAY JUSTESEN 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
1	207Q00000X	Family Medicine Physician	04-28962	KS
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	04-28962	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639122302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY RAY JUSTESEN MD

Provider Business Mailing Address
First Line	:	20805 W 151ST ST
Second Line	:	SUITE 200
City	:	OLATHE
State	:	KS
Zip	:	66061-7249
Country	:	US
Telephone Number	:	913-324-8571
Fax Number	:

Provider Business Practice Location Address
First Line	:	20805 W 151ST ST
Second Line	:	SUITE 200
City	:	OLATHE
State	:	KS
Zip	:	66061-7249
Country	:	US
Telephone Number	:	913-324-8571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	01/04/2022

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