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Individual
DR. JOHNATHON DAVID JUSTICE
Active
Individual
DR. JOHNATHON DAVID JUSTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64039
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64039
WI STATE LIC
WI
Enumeration date
05/20/2012
Last updated
07/07/2015
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