Provider Demographics
NPI:1417959107
Name:PALMER, STEPHEN RALPH (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RALPH
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:320 E FONTANERO ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7529
Mailing Address - Country:US
Mailing Address - Phone:719-471-2462
Mailing Address - Fax:719-574-4974
Practice Address - Street 1:7720 S BROADWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2632
Practice Address - Country:US
Practice Address - Phone:303-832-2462
Practice Address - Fax:303-832-2466
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO411222080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00386235Medicaid
CO00386235Medicaid