Provider Demographics
NPI:1538398458
Name:JUSTICE, JOSEPH EDWARD I (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:JUSTICE
Suffix:I
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:EDWARD
Other - Last Name:JUSTICE
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:928 PRINCESS DIANA DR
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-4088
Mailing Address - Country:US
Mailing Address - Phone:830-367-5917
Mailing Address - Fax:
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:830-367-5917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical