Provider Demographics
NPI:1134136674
Name:JUSTICE, JOSEPH B (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 US RT 60 EAST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705
Mailing Address - Country:US
Mailing Address - Phone:304-528-4635
Mailing Address - Fax:304-528-4673
Practice Address - Street 1:5170 US RT 60 EAST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705
Practice Address - Country:US
Practice Address - Phone:304-528-4635
Practice Address - Fax:304-528-4673
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080159078OtherRAILROAD MEDICARE
WV0047307000Medicaid
OH2220322Medicaid
080159078OtherRAILROAD MEDICARE
0889492Medicare PIN