Provider Demographics
NPI:1396076469
Name:DAVID A. PALMORE M.D. INC.
Entity type:Organization
Organization Name:DAVID A. PALMORE M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:KARINA
Authorized Official - Last Name:PALMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-779-0399
Mailing Address - Street 1:1187 E HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3166
Mailing Address - Country:US
Mailing Address - Phone:559-449-4547
Mailing Address - Fax:559-761-1530
Practice Address - Street 1:1187 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3166
Practice Address - Country:US
Practice Address - Phone:559-449-4547
Practice Address - Fax:559-761-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B48093Medicare UPIN