Healthcare Provider Details

I. General information

NPI: 1740399765
Provider Name (Legal Business Name): ERIC C PALMQUIST DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 N 167TH CT SUITE 115
OMAHA NE
68116-8070
US

IV. Provider business mailing address

3821 N 167TH CT SUITE 115
OMAHA NE
68116-8070
US

V. Phone/Fax

Practice location:
  • Phone: 402-315-4406
  • Fax: 402-885-6991
Mailing address:
  • Phone: 402-315-4406
  • Fax: 402-885-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005313
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00799
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number342
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: