MEDICARE: JENNIFER LILLIAN PALMER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	27747	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801893862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LILLIAN PALMER M.D.

Provider Business Mailing Address
First Line	:	WESTPOORT MEDICAL PLAZA
Second Line	:	2605 WASHINGTON STREET
City	:	PELLA
State	:	IA
Zip	:	50219
Country	:	US
Telephone Number	:	641-620-9119
Fax Number	:	641-613-1305

Provider Business Practice Location Address
First Line	:	WESTPOORT MEDICAL PLAZA
Second Line	:	2605 WASHINGTON STREET
City	:	PELLA
State	:	IA
Zip	:	50219
Country	:	US
Telephone Number	:	641-620-9119
Fax Number	:	641-613-1305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	09/14/2011

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