Provider Demographics
NPI:1770648404
Name:ERIK G. PALMER, D.O., A MEDICAL CORP
Entity Type:Organization
Organization Name:ERIK G. PALMER, D.O., A MEDICAL CORP
Other - Org Name:DESERT FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:GROVE
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-323-4272
Mailing Address - Street 1:555 E TACHEVAH DR
Mailing Address - Street 2:SUITE 2W-203
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5750
Mailing Address - Country:US
Mailing Address - Phone:760-323-4272
Mailing Address - Fax:760-323-8597
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:SUITE 2W-203
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5750
Practice Address - Country:US
Practice Address - Phone:760-323-4272
Practice Address - Fax:760-323-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01493ZOtherBLUE SHIELD
CAZZZ01493ZOtherBLUE SHIELD