Provider Demographics
NPI:1639160203
Name:JUSTO, RORY D (MD)
Entity Type:Individual
Prefix:DR
First Name:RORY
Middle Name:D
Last Name:JUSTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:TN
Mailing Address - Zip Code:37347-5477
Mailing Address - Country:US
Mailing Address - Phone:423-942-9171
Mailing Address - Fax:423-942-9128
Practice Address - Street 1:24 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:TN
Practice Address - Zip Code:37347-5477
Practice Address - Country:US
Practice Address - Phone:423-942-9171
Practice Address - Fax:423-942-9128
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD31741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH05983Medicare UPIN