Provider Demographics
NPI:1003856212
Name:PALERMO, LOUIS MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:MARTIN
Last Name:PALERMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23506
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-3506
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-828-0723
Practice Address - Street 1:1855 JESSICA RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1508
Practice Address - Country:US
Practice Address - Phone:727-518-2240
Practice Address - Fax:727-796-7660
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39364207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066447200Medicaid
P00235208OtherRAILROAD MCR
FL93976OtherBCBS OF FL
FL93976OtherBCBS OF FL
D63080Medicare UPIN