Provider Demographics
NPI:1750301545
Name:PALMQUIST, ROLAND ALLEN (DPM)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:ALLEN
Last Name:PALMQUIST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8958 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-8088
Mailing Address - Country:US
Mailing Address - Phone:928-667-4494
Mailing Address - Fax:
Practice Address - Street 1:12033 AGENCY RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-7718
Practice Address - Country:US
Practice Address - Phone:928-669-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPOD-2213ES0103X
CAE3868213ES0103X
AZ635213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ749096Medicaid
AZHSZ136Medicare PIN
8HBD49Medicare PIN
8HBD52Medicare PIN
AZ749096Medicaid