Provider Demographics
NPI:1346333572
Name:JUSTICE, STEPHEN FRANCIS (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FRANCIS
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 1:2305 GEORGIA STREET
Mailing Address - Street 2:
Mailing Address - City:LOUISIANA
Mailing Address - State:MO
Mailing Address - Zip Code:63353
Mailing Address - Country:US
Mailing Address - Phone:573-754-4584
Mailing Address - Fax:573-754-5280
Practice Address - Street 1:2305 GEORGIA
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353
Practice Address - Country:US
Practice Address - Phone:573-754-4584
Practice Address - Fax:573-754-5280
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORIE27207Q00000X
MOR1E27207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10262700OtherBLUE CROSS BLUE SHIELD
MO242101103Medicaid
MO10262700OtherBLUE CROSS BLUE SHIELD
MO242101103Medicaid