Provider Demographics
NPI:1831321322
Name:POISSANT, JUSTIN DANA (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DANA
Last Name:POISSANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HOSPITAL
Mailing Address - Street 2:6000 W HWY 98
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0003
Mailing Address - Country:US
Mailing Address - Phone:850-505-6472
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL 6000 W HWY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0003
Practice Address - Country:US
Practice Address - Phone:850-505-6199
Practice Address - Fax:850-505-6484
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2019-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12796207Q00000X
MEDO2256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty