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Individual
SAMUEL JOE JUSTISS
Active
Individual
SAMUEL JOE JUSTISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06923
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
219693301
—
TX
01
—
838N78
BCBS
TX
Enumeration date
10/22/2010
Last updated
11/21/2016
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