Basic Information
| Provider Information | |||||||||
| NPI: | 1598035370 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RUSSEL S. PALMER M.D.,P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2699 STIRLING RD | ||||||||
| Address2: | SUITE B101 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333126517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549895001 | ||||||||
| FaxNumber: | 9549612433 | ||||||||
| Practice Location | |||||||||
| Address1: | 2699 STIRLING RD | ||||||||
| Address2: | SUITE B101 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333126517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549895001 | ||||||||
| FaxNumber: | 9549612433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2012 | ||||||||
| LastUpdateDate: | 09/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | PALMER | ||||||||
| AuthorizedOfficialFirstName: | RUSSEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9549895001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D., P.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.