Provider Demographics
NPI:1821134057
Name:VENABLE, JUSTIN NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:NEIL
Last Name:VENABLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3470 CALUMET DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-7410
Mailing Address - Country:US
Mailing Address - Phone:318-222-2559
Mailing Address - Fax:
Practice Address - Street 1:ROUTES 28 55
Practice Address - Street 2:GRANT MEMORIAL HOSPITAL DRIVE
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1019
Practice Address - Country:US
Practice Address - Phone:304-257-1026
Practice Address - Fax:304-257-2537
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV22529208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery