Individual
JERRY DEAN PALMORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3701 W COMMERCE ST, SAN ANTONIO, TX 78207-3611
(210) 434-0531
(210) 434-0321
Mailing address
9031 KOENIG, SAN ANTONIO, TX 78251-2933
(210) 303-0666
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
8959
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14379906
—
TX
Enumeration date
01/11/2019
Last updated
01/11/2019
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