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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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