Individual
MR. EUGENE STANLEY JUSTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
533 E COUNTY LINE RD STE 101, GREENWOOD, IN 46143-1074
(317) 957-9050
(317) 957-9952
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
(317) 621-7584
(317) 957-2705
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001103B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000353149
BLUE CROSS BLUE SHIELD
IN
05
—
200051160
—
IN
01
—
P01424410
RAIL ROAD PTAN
IN
Enumeration date
07/07/2005
Last updated
11/27/2023
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