Individual
DR. JOHNATHON DAVID JUSTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
704 S CLARK ST, THORP, WI 54771-7624
(715) 669-7279
Mailing address
704 S CLARK ST, THORP, WI 54771-7624
(715) 669-7279
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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