Healthcare Provider Details

I. General information

NPI: 1417959107
Provider Name (Legal Business Name): STEPHEN RALPH PALMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 S BROADWAY SUITE 110
LITTLETON CO
80122-2632
US

IV. Provider business mailing address

320 E FONTANERO ST SUITE 308
COLORADO SPRINGS CO
80907-7529
US

V. Phone/Fax

Practice location:
  • Phone: 303-832-2462
  • Fax: 303-832-2466
Mailing address:
  • Phone: 719-471-2462
  • Fax: 719-574-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number41122
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: