Provider Demographics
NPI:1588642128
Name:JUSTICE, JAMES L (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:855 A AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5057
Mailing Address - Country:US
Mailing Address - Phone:319-362-0200
Mailing Address - Fax:319-362-5186
Practice Address - Street 1:855 A AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5057
Practice Address - Country:US
Practice Address - Phone:319-362-0200
Practice Address - Fax:319-362-5186
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-05-17
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Provider Licenses
StateLicense IDTaxonomies
IA25580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1588642128Medicaid
IA0058917Medicaid
IA010041842OtherRR MEDICARE
IA010041842OtherRR MEDICARE
IAC43092Medicare UPIN