Healthcare Provider Details

I. General information

NPI: 1609469402
Provider Name (Legal Business Name): PALM ORTHOPEDICS & INTERVENTIONAL PAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 NW 71ST CT STE 201
TAMARAC FL
33321-2931
US

IV. Provider business mailing address

PO BOX 16535
PLANTATION FL
33318-6535
US

V. Phone/Fax

Practice location:
  • Phone: 954-747-1221
  • Fax:
Mailing address:
  • Phone: 954-747-1221
  • Fax: 954-747-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIAN CAMERON
Title or Position: OWNER
Credential: M.D.
Phone: 954-747-1221