Provider Demographics
NPI:1598035370
Name:RUSSEL S. PALMER M.D.,P.A.
Entity Type:Organization
Organization Name:RUSSEL S. PALMER M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:954-989-5001
Mailing Address - Street 1:2699 STIRLING RD
Mailing Address - Street 2:SUITE B101
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6517
Mailing Address - Country:US
Mailing Address - Phone:954-989-5001
Mailing Address - Fax:954-961-2433
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:SUITE B101
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-989-5001
Practice Address - Fax:954-961-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty