Healthcare Provider Details

I. General information

NPI: 1831194133
Provider Name (Legal Business Name): GREG PALMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: D GREG PALMER MD

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 BRIDGEWAY ST SUITE 201
AURORA IN
47001-1378
US

IV. Provider business mailing address

107 BRIDGEWAY ST SUITE 201
AURORA IN
47001-1378
US

V. Phone/Fax

Practice location:
  • Phone: 812-926-0814
  • Fax: 812-926-2825
Mailing address:
  • Phone: 812-926-0814
  • Fax: 812-926-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35052001
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01033594A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: