NPIMap

Organization Active NPI

Dermatology Laser Surgery Center Inc

Doing business as Dr Palmer

  • Procedural Dermatology Physician
  • Centerville Finance, OH
National Provider Identifier
1619096708
Registry record updated Nov 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
35043172 Issued in OH
Legal business name
DERMATOLOGY LASER SURGERY CENTER INC
Doing business as
Dr Palmer
Practice address
6720 Loop Rd
Centerville Finance, OH 45459-2161
Phone
(937) 433-4922
Fax
(937) 433-6520
NPI assigned
Mar 28, 2007
Last updated
Nov 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2008

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

Authorized official

Name
Gary D Palmer, M DNPI 1134124563
Title
Medical Doctor Pres.
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
Procedural Dermatology Physician 207NS0135X 35043172 OH Primary

Addresses

Primary practice location

6720 Loop Rd
Centerville Finance, OH 45459-2161

Mailing address

6720 Loop Rd
Centerville Finance, OH 45459-2161
Phone (937) 433-4922

Other identifiers 2

IdentifierTypeStateIssuer
DE181759OtherOHMEDIGAP NUMBER
402741848001OtherOHMEDICAL MUTUAL

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.

Locations

6720 Loop Rd
Dayton, OH 45459
Phone (513) 433-4922

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": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227225600000",
    "number": "1619096708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6720 LOOP RD",
            "city": "CENTERVILLE FINANCE",
            "state": "OH",
            "postal_code": "454592161",
            "telephone_number": "937-433-4922",
            "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 FINANCE",
            "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": "2007-03-28",
        "last_updated": "2008-11-21",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DOCTOR PRES.",
        "authorized_official_telephone_number": "937-433-4922",
        "authorized_official_credential": "M D"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "OH",
            "license": "35043172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDIGAP NUMBER",
            "identifier": "DE181759",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL",
            "identifier": "402741848001",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Palmer",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville Finance, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2008; 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.