Healthcare Provider Details

I. General information

NPI: 1316153018
Provider Name (Legal Business Name): THOMAS R. PALMER DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6108 NE GLISAN ST
PORTLAND OR
97213-3864
US

IV. Provider business mailing address

6108 NE GLISAN ST
PORTLAND OR
97213-3864
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-8100
  • Fax: 503-255-2728
Mailing address:
  • Phone: 503-255-8100
  • Fax: 503-255-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP00202
License Number StateOR

VIII. Authorized Official

Name: DR. THOMAS R PALMER
Title or Position: OWNER
Credential: DPM
Phone: 503-255-8100