Provider Demographics
NPI:1558247940
Name:DUVALL, JUSTIN L
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:L
Last Name:DUVALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1928
Mailing Address - Country:US
Mailing Address - Phone:937-844-6721
Mailing Address - Fax:
Practice Address - Street 1:1649 PARK RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:OH
Practice Address - Zip Code:43084-9713
Practice Address - Country:US
Practice Address - Phone:937-826-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator