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General NPI Number Information
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NPI Number | 1215682943
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Entity Type | Individual
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Provider Name | JUSTIN ELAN PALM DO
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Gender | Male
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Dates
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Enumeration Date | 02/22/2022
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | MISAWA AIR BASE 35TH MDG FLIGHT BUILDING 99, UNIT 5024
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City | APO
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State | AP
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Zip | 96319
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Country | US
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Telephone | 17-677-6133
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Fax |
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Provider Business Mailing Address
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Address Line | 36TH MEDICAL GROUP UNIT 14010 BLDG. 26012 ANDERSEN AFB
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City | APO
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State | AP
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Zip | 96543
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Country | US
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Telephone | 315-366-3542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | DR.0071574
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License Number State | CO
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