Basic Information
| Provider Information | |||||||||
| NPI: | 1689834046 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | POSSNER | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9225 N 3RD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850202439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024450751 | ||||||||
| FaxNumber: | 6024248128 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | DOVE CREEK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813244900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706772291 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 005348 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0059366 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.