Healthcare Provider Details

I. General information

NPI: 1659486330
Provider Name (Legal Business Name): LUIS E PALACIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E STADIUM WAY
RENO NV
89557-7917
US

IV. Provider business mailing address

1155 MILL ST # MCM14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-1000
  • Fax: 775-982-8045
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number13303
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: