Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2016032298 | MO |
N | 207X00000X | Orthopaedic Surgeon | 49721 | KY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 54531 | TN |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | DR.0063541 | CO |
N | 208D00000X | General Practice Physician | MD-16545 | HI |
NPI | 1205120177 |
---|---|
Provider Name | Dr. Justin J Ernat |
First Address | Clarksville, TN 37043-9306 |
Second Address | Vail, CO 81657-5242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 25/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1205120177 | NPI (01) | |
VAD000 | (02) |