Individual
SALLY PALMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12511 WORLD PLAZA LN BLDG 50, FORT MYERS, FL 33907-3991
(239) 939-2622
(239) 939-0151
Mailing address
94341 MONTEVERDI WAY, FORT MYERS, FL 33912
(239) 939-2622
(239) 939-0151
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME0075826
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
221633
AMERIGROUP
—
05
—
253942000
—
FL
01
—
43450
BC/BS FL
FL
01
—
50061845
RAILROAD MEDICARE
FL
Enumeration date
01/24/2006
Last updated
02/28/2013
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