NPIMap

Organization Active NPI

Dermatology Laser Surgery Center Inc

Doing business as dr palmer

  • Dermatology Physician
  • Centerville, OH
National Provider Identifier
1598982704
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
35043176 Issued in OH
Legal business name
DERMATOLOGY LASER SURGERY CENTER INC
Doing business as
dr palmer
Practice address
6720 Loop Rd
Centerville, OH 45459-2161
Phone
(937) 433-4922
Fax
(937) 433-6520
NPI assigned
Apr 19, 2007
Last updated
Nov 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary D Palmer, MDNPI 1134124563
Title
Medical President
Phone
(937) 433-4922

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 35043176 OH Primary

Addresses

Primary practice location

6720 Loop Rd
Centerville, OH 45459-2161

Mailing address

3723 Hauck Rd
Cincinnati, OH 45241
Phone (513) 769-8346

Other identifiers 3

IdentifierTypeStateIssuer
402741848001OtherOHMEDICAL MUTUAL
DE181759OtherOHMEDIGAP NUMBER
15317OtherOHANTHEM

Other names 1

  • dr palmer Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dermatology Laser Surgery Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1598982704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3723 HAUCK RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45241",
            "telephone_number": "513-769-8346",
            "fax_number": "937-433-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6720 LOOP RD",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454592161",
            "telephone_number": "937-433-4922",
            "fax_number": "937-433-6520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY LASER SURGERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL PRESIDENT",
        "authorized_official_telephone_number": "937-433-4922",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "OH",
            "license": "35043176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL",
            "identifier": "402741848001",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDIGAP NUMBER",
            "identifier": "DE181759",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "15317",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dr palmer",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.