Provider Demographics
NPI:1780249896
Name:JUSTICE, SETH DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:DANIEL
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-851-7400
Mailing Address - Fax:501-851-4753
Practice Address - Street 1:1800 BYPASS ROAD
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-9135
Practice Address - Country:US
Practice Address - Phone:501-851-7400
Practice Address - Fax:501-851-4753
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-15137207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program