Individual
MR. JUSTIN L NORTHCUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8 DOCTORS PARK RD, MOUNT VERNON, IL 62864-6224
(618) 244-5500
Mailing address
12415 SOMERSET PLACE DR APT J, SAINT LOUIS, MO 63128-2243
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007547
IL
Other
Enumeration date
03/17/2020
Last updated
03/17/2020
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