Healthcare Provider Details

I. General information

NPI: 1174818710
Provider Name (Legal Business Name): DREW A PALMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 W SAINT ISABEL ST
TAMPA FL
33607-6320
US

IV. Provider business mailing address

PO BOX 26026
TAMPA FL
33623-6026
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-7434
  • Fax:
Mailing address:
  • Phone: 813-356-0196
  • Fax: 813-356-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number247721
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME134811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: