Individual
JUSTIN KENT ROULSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1921 STONECIPHER BLVD, ADA, OK 74820
(580) 421-4570
Mailing address
1921 STONECIPHER BLVD, ADA, OK 74820
(580) 421-4570
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5115
OK
Other
Enumeration date
07/20/2011
Last updated
09/15/2016
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