Healthcare Provider Details

I. General information

NPI: 1629096326
Provider Name (Legal Business Name): MICHAEL LAWTON PALMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE
JACKSON MS
39216-5116
US

IV. Provider business mailing address

108 BROADFOOT CIR
RIDGELAND MS
39157-9793
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-364-1459
Mailing address:
  • Phone: 601-853-0222
  • Fax: 601-364-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number09165
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: