Individual
MR. JUSTIN RAY LANCASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
5301 BAINBRIDGE AVE, GULFPORT, MS 39501-9026
(228) 871-4158
Mailing address
2005 OVERLAND TRL, CORPUS CHRISTI, TX 78410-1857
(619) 379-4166
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/11/2010
Last updated
05/11/2010
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