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General NPI Number Information
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NPI Number | 1134124563
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Entity Type | Individual
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Provider Name | GARY D PALMER MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 6720 LOOP RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-2161
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Country | US
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Telephone | 937-433-4922
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Fax | 937-433-6520
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Provider Business Mailing Address
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Address Line | 6720 LOOP RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-2161
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Country | US
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Telephone | 937-433-4922
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Fax | 937-433-6520
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35043172
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License Number State | OH
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