Provider Demographics
NPI:1891349585
Name:JACQUES J PALMER M D INC
Entity Type:Organization
Organization Name:JACQUES J PALMER M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-1060
Mailing Address - Street 1:30832 VIA CONQUISTA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1736
Mailing Address - Country:US
Mailing Address - Phone:949-364-1060
Mailing Address - Fax:949-364-5761
Practice Address - Street 1:30832 VIA CONQUISTA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1736
Practice Address - Country:US
Practice Address - Phone:949-364-1060
Practice Address - Fax:949-364-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty