Provider Demographics
NPI:1912959289
Name:PALMER, ELISSA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:J
Last Name:PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3016 W CHARLESTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1973
Mailing Address - Country:US
Mailing Address - Phone:702-780-7118
Mailing Address - Fax:702-992-6880
Practice Address - Street 1:1524 PINTO LN FL 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4195
Practice Address - Country:US
Practice Address - Phone:702-992-6888
Practice Address - Fax:702-992-6880
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD056289L207Q00000X
NV11861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA203248OtherUPMC HEALTH PLAN
PA20660OtherGEISINGER HEALTH PLAN
E23649OtherUPIN
080097534OtherRAILROAD MEDICARE
PA644803OtherHIGHMARK BC/BS
PA74016OtherUNISON HEALTH PLAN
PA85662OtherUNISON HEALTH PLAN OB
PA0015405270004Medicaid
PA1546798OtherGATEWAY HEALTH PLAN OB
PAP000241OtherGATEWAY HEALTH PLAN
PA0015405270004Medicaid