Provider Demographics
NPI:1437353828
Name:DAPHNE PALMER MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAPHNE PALMER MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-582-1054
Mailing Address - Street 1:PO BOX 26706
Mailing Address - Street 2:SECTION #3093
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0706
Mailing Address - Country:US
Mailing Address - Phone:530-582-1054
Mailing Address - Fax:530-550-1595
Practice Address - Street 1:1155 MILL ST L 11
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1474
Practice Address - Country:US
Practice Address - Phone:775-982-5638
Practice Address - Fax:775-982-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV112542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty