Individual
DR. EDMUNDO SAMUEL JUSTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
802 AINSWORTH DR STE A, PRESCOTT, AZ 86301-1623
(928) 771-5548
(928) 771-5549
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
11931
ND
207RG0100X
Gastroenterology Physician
Primary
60368
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007145
—
AZ
05
—
215032801
—
TX
01
—
60368
MEDICAL LICENSE
AZ
01
—
TXB107550
MEDICARE PTAN
TX
Enumeration date
12/01/2006
Last updated
09/29/2025
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