Provider Demographics
NPI:1619977444
Name:PALMORE, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:PALMORE
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 1:1187 E HERNDON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3166
Mailing Address - Country:US
Mailing Address - Phone:559-449-4548
Mailing Address - Fax:559-472-9960
Practice Address - Street 1:1187 E HERNDON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3166
Practice Address - Country:US
Practice Address - Phone:559-449-4548
Practice Address - Fax:559-472-9960
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110038105OtherMEDICARE UNSPECIFIED
CAB48093Medicare UPIN
CA00A492630Medicare ID - Type Unspecified