Healthcare Provider Details

I. General information

NPI: 1508136805
Provider Name (Legal Business Name): WILLIAM EWING PALMER JR. M, D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2199 ROUTE 381
RECTOR PA
15677-1609
US

IV. Provider business mailing address

2199 ROUTE 381
RECTOR PA
15677-1609
US

V. Phone/Fax

Practice location:
  • Phone: 724-593-2216
  • Fax:
Mailing address:
  • Phone: 724-593-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD026317L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: