Provider Demographics
NPI:1285622969
Name:PALMA, CANDIDIO ROBERTO (M,D)
Entity type:Individual
Prefix:DR
First Name:CANDIDIO
Middle Name:ROBERTO
Last Name:PALMA
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3607
Mailing Address - Country:US
Mailing Address - Phone:954-565-8282
Mailing Address - Fax:954-565-8994
Practice Address - Street 1:910 NE 26TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3607
Practice Address - Country:US
Practice Address - Phone:954-565-8282
Practice Address - Fax:954-565-8994
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 39072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63062Medicare UPIN
FL93935Medicare ID - Type UnspecifiedPROVIDER NUMBER