Healthcare Provider Details

I. General information

NPI: 1811088115
Provider Name (Legal Business Name): HERMAN TALMADGE PALMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S FOURTH ST
BALDWYN MS
38824-2114
US

IV. Provider business mailing address

529 S FOURTH ST
BALDWYN MS
38824-2114
US

V. Phone/Fax

Practice location:
  • Phone: 662-365-2222
  • Fax:
Mailing address:
  • Phone: 662-365-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number09648
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: