Provider Demographics
NPI:1952676678
Name:PALMER, RYAN DEAN (AS-C)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DEAN
Last Name:PALMER
Suffix:
Gender:M
Credentials:AS-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3162 N 525 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7518
Mailing Address - Country:US
Mailing Address - Phone:801-337-0437
Mailing Address - Fax:
Practice Address - Street 1:3162 N 525 E
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7518
Practice Address - Country:US
Practice Address - Phone:801-337-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant