Healthcare Provider Details

I. General information

NPI: 1891171955
Provider Name (Legal Business Name): JUSTIN MATTHEW PALMER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 3RD ST SE # SUIRE150
LOVELAND CO
80537-6419
US

IV. Provider business mailing address

2930 11TH AVE
EVANS CO
80620-1011
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-4855
  • Fax: 970-669-7389
Mailing address:
  • Phone: 970-353-9403
  • Fax: 970-353-5884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0006533
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: