Provider Demographics
NPI:1851552459
Name:PALMER, RUSSELL LEON JR (RT, BS)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:LEON
Last Name:PALMER
Suffix:JR
Gender:M
Credentials:RT, BS
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Mailing Address - Street 1:1045 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1731
Mailing Address - Country:US
Mailing Address - Phone:928-777-9064
Mailing Address - Fax:928-777-9183
Practice Address - Street 1:214 WHITE SPAR RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4236
Practice Address - Country:US
Practice Address - Phone:928-777-9064
Practice Address - Fax:928-777-9183
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-18
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Provider Licenses
StateLicense IDTaxonomies
AZCRT-5873247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71261Medicare PIN