Provider Demographics
NPI:1770862971
Name:ROUSSEAU, JUSTIN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:F
Last Name:ROUSSEAU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1912 SPEEDWAY
Mailing Address - Street 2:SUITE 546
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1235
Mailing Address - Country:US
Mailing Address - Phone:512-495-5192
Mailing Address - Fax:844-278-9686
Practice Address - Street 1:1600 W 38TH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6400
Practice Address - Country:US
Practice Address - Phone:512-324-3540
Practice Address - Fax:512-324-3541
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2017-03-24
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Provider Licenses
StateLicense IDTaxonomies
TXR03142084N0400X, 2083C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365876701Medicaid
TX365876702Medicaid
TX538954YL9XMedicare PIN
TX538954YMGJMedicare PIN