Provider Demographics
NPI:1396815965
Name:PALCHAK, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:PALCHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93448-0579
Mailing Address - Country:US
Mailing Address - Phone:805-474-9143
Mailing Address - Fax:805-474-9569
Practice Address - Street 1:584 CAMINO MERCADO
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1816
Practice Address - Country:US
Practice Address - Phone:805-474-9143
Practice Address - Fax:805-474-9569
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60994207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110116966OtherRAILROAD MEDICARE
CA00G609940OtherBLUE SHIELD
CA77-0368079OtherBLUE CROSS
CA00G609941Medicaid
CA00G609941Medicaid
CAE93101Medicare UPIN
CAG60994Medicare ID - Type Unspecified
CA6504890001Medicare NSC