Healthcare Provider Details

I. General information

NPI: 1467983429
Provider Name (Legal Business Name): ELIZABETH JUEL MRAMOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 12/13/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMP FOSTER STILLWILL DRIVE BUILDING 449
FPO AP
96362
US

IV. Provider business mailing address

PSC 482 BOX 1600
FPO AP
96362-0017
US

V. Phone/Fax

Practice location:
  • Phone: 315-645-7182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01080866A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: