Provider Demographics
NPI:1649699638
Name:PALMER, ANGELA WILCOX (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:WILCOX
Last Name:PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ANGELA
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 95306
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-5306
Mailing Address - Country:US
Mailing Address - Phone:702-851-0792
Mailing Address - Fax:702-851-0797
Practice Address - Street 1:8530 W SUNSET RD STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2245
Practice Address - Country:US
Practice Address - Phone:702-851-0792
Practice Address - Fax:702-851-0797
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV20355207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program