Healthcare Provider Details

I. General information

NPI: 1275852584
Provider Name (Legal Business Name): MICHAEL JAMES ELLETT MONSON D.O., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVAL HOSPITAL, OKINAWA
FPO AP
96362
JP

IV. Provider business mailing address

PSC 559 BOX 5254
FPO AP
96377-0053
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2019-00499
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberDO-0122
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDO-0122
License Number StateGU
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2019-00499
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: