Healthcare Provider Details

I. General information

NPI: 1336221779
Provider Name (Legal Business Name): JAMES V PALERMO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 US HIGHWAY 1
ROCKLEDGE FL
32955-5747
US

IV. Provider business mailing address

PO BOX 561600
ROCKLEDGE FL
32956-1600
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-4393
  • Fax:
Mailing address:
  • Phone: 321-434-4656
  • Fax: 321-259-5130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME44552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: