Provider Demographics
NPI:1659486330
Name:PALACIO, LUIS E (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:PALACIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-8045
Practice Address - Street 1:101 E STADIUM WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-7917
Practice Address - Country:US
Practice Address - Phone:775-982-1000
Practice Address - Fax:775-982-8045
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV13303207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11640462OtherCAQH
NV1659486330Medicaid
1659486330OtherNPI