1205896024 NPI number — DAPHNE PALMER MD

Table of content: DAPHNE PALMER MD (NPI 1205896024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205896024 NPI number — DAPHNE PALMER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMER
Provider First Name:
DAPHNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205896024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10121 PINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUCKEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96161-4835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-582-6450
Provider Business Mailing Address Fax Number:
530-582-6430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10121 PINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUCKEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96161-4835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-582-6450
Provider Business Practice Location Address Fax Number:
530-582-6430
Provider Enumeration Date:
03/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  11254 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: G55391 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1205896024 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10966232 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".