Healthcare Provider Details

I. General information

NPI: 1528164241
Provider Name (Legal Business Name): BRET L PALMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NW 49TH ST SUITE 140
FORT LAUDERDALE FL
33309-3723
US

IV. Provider business mailing address

1501 NW 49TH ST SUITE 140
FORT LAUDERDALE FL
33309-3723
US

V. Phone/Fax

Practice location:
  • Phone: 954-714-6351
  • Fax:
Mailing address:
  • Phone: 954-714-6351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number241435
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME114494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: