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NPI Code Detail

MEDICARE: MR. JOHN ROBERT PALMORE JR. PA-C

MEDICARE:  MR. JOHN ROBERT PALMORE JR. PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1700141116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN ROBERT PALMORE JR. PA-C
Provider Business Mailing Address
First Line : 6600 S YALE AVE
Second Line : SUITE 1400
City : TULSA
State : OK
Zip : 74136-3347
Country : US
Telephone Number : 918-488-6001
Fax Number :
Provider Business Practice Location Address
First Line : 1840 S WASHINGTON AVE
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-4716
Country : US
Telephone Number : 321-360-5577
Fax Number : 321-806-2087
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2012
Last Update Date : 10/16/2024

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Directions to “ MR. JOHN ROBERT PALMORE JR. PA-C” Practice Location

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