Provider Demographics
NPI:1922043439
Name:PALOMADO, RAUL P (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:P
Last Name:PALOMADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W MAIN ST
Mailing Address - Street 2:PO BOX 1357
Mailing Address - City:BOWLING GREEN
Mailing Address - State:FL
Mailing Address - Zip Code:33834-5053
Mailing Address - Country:US
Mailing Address - Phone:863-375-2214
Mailing Address - Fax:863-375-2212
Practice Address - Street 1:302 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:FL
Practice Address - Zip Code:33834-5053
Practice Address - Country:US
Practice Address - Phone:863-375-2214
Practice Address - Fax:863-375-2212
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 49281208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039232400Medicaid
FLE22522Medicare UPIN
FL08534Medicare ID - Type UnspecifiedMEDICARE NUMBER