Organization
DERMATOLOGY LASER SURGERY CENTER INC
Active
Organization
DERMATOLOGY LASER SURGERY CENTER INC
Active
Other names
dr palmer
Organization subpart
No
Provider details
NPI number
Authorized official
GARY D PALMER MD (MEDICAL PRESIDENT)
(937) 433-4922
Entity
Organization
Contact information
Practice address
6720 LOOP RD, CENTERVILLE, OH 45459-2161
(937) 433-4922
(937) 433-6520
Mailing address
3723 HAUCK RD, CINCINNATI, OH 45241
(513) 769-8346
(937) 433-6520
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35043176
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15317
ANTHEM
OH
01
—
402741848001
MEDICAL MUTUAL
OH
01
—
DE181759
MEDIGAP NUMBER
OH
Enumeration date
04/19/2007
Last updated
11/18/2011
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