Provider Demographics
NPI:1548244536
Name:JUSTICE, TERRY EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:EUGENE
Last Name:JUSTICE
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 1:706 23RD ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2832
Mailing Address - Country:US
Mailing Address - Phone:606-329-0060
Mailing Address - Fax:606-325-9366
Practice Address - Street 1:706 23RD ST
Practice Address - Street 2:TRI-STATE REGIONAL CANCER CENTER
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2832
Practice Address - Country:US
Practice Address - Phone:606-329-0060
Practice Address - Fax:606-325-9366
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY386572085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2494439Medicaid
KY64084700Medicaid
KY1402404Medicare ID - Type Unspecified
OH2494439Medicaid