Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | P20503 | NC |
NPI | 1063089910 |
---|---|
Provider Name | Dr. John Justyn |
First Address | Centennial, CO 80112-1050 |
Second Address | Centennial, CO 80112-1050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2021 |
Last Update Date | 09/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P20503 | STATE LICENSE (01) | NC |