Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2116362 | TX |
Y | 213ES0000X | Sports Medicine | 2116362 | TX |
NPI | 1205506300 |
---|---|
Provider Name | Mr. Justin Keith Juneau |
First Address | Humble, TX 77346-4851 |
Second Address | Humble, TX 77346-4851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2021 |
Last Update Date | 20/09/2021 |