Provider Demographics
NPI:1851752257
Name:PALMON, LILLIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:
Last Name:PALMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 MAHOGANY RUN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8114
Mailing Address - Country:US
Mailing Address - Phone:239-768-6346
Mailing Address - Fax:239-768-0003
Practice Address - Street 1:11250 MAHOGANY RUN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8114
Practice Address - Country:US
Practice Address - Phone:239-768-6346
Practice Address - Fax:239-768-0003
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME671802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology