Basic Information
| Provider Information | |||||||||
| NPI: | 1780249896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUSTICE | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11001 EXECUTIVE CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018517400 | ||||||||
| FaxNumber: | 5018514753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 BYPASS ROAD | ||||||||
| Address2: | |||||||||
| City: | HEBER SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725439135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018517400 | ||||||||
| FaxNumber: | 5018514753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2019 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | E-15137 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.