Provider Demographics
NPI:1982631313
Name:JUSTISS, RICHARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:JUSTISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4010 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7000
Mailing Address - Country:US
Mailing Address - Phone:870-541-6008
Mailing Address - Fax:870-541-3198
Practice Address - Street 1:1222 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7109
Practice Address - Country:US
Practice Address - Phone:870-535-1819
Practice Address - Fax:870-534-3340
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC5209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106370001Medicaid
AR52779Medicare PIN
ARC68604Medicare UPIN