Basic Information
| Provider Information | |||||||||
| NPI: | 1831321322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POISSANT | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | DANA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | NAVAL HOSPITAL | ||||||||
| Address2: | 6000 W HWY 98 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325120003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505056472 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NAVAL HOSPITAL 6000 W HWY 98 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325120003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505056199 | ||||||||
| FaxNumber: | 8505056484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2009 | ||||||||
| LastUpdateDate: | 05/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS12796 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO2256 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.