Provider Demographics
NPI:1407812647
Name:JUSTO, EMILIO M (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:M
Last Name:JUSTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22057
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-2057
Mailing Address - Country:US
Mailing Address - Phone:623-876-2020
Mailing Address - Fax:623-975-7005
Practice Address - Street 1:10701 W BELL RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1074
Practice Address - Country:US
Practice Address - Phone:623-876-2020
Practice Address - Fax:623-975-7005
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18595207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ056392Medicaid
E69631Medicare UPIN
AZ056392Medicaid
AZ180007926Medicare PIN