Healthcare Provider Details

I. General information

NPI: 1982647467
Provider Name (Legal Business Name): THOMAS R PALMER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/02/2009
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:
Title or Position:
Credential:
Phone: