Provider Demographics
NPI:1740399765
Name:PALMQUIST, ERIC C (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:PALMQUIST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 N 167TH CT
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8070
Mailing Address - Country:US
Mailing Address - Phone:402-315-4406
Mailing Address - Fax:402-885-6991
Practice Address - Street 1:3821 N 167TH CT
Practice Address - Street 2:SUITE 115
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8070
Practice Address - Country:US
Practice Address - Phone:402-315-4406
Practice Address - Fax:402-885-6991
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005313213ES0103X
IA00799213ES0103X
NE342213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1740399765Medicare PIN