Healthcare Provider Details

I. General information

NPI: 1841498730
Provider Name (Legal Business Name): BARRON MARK PALMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2017
US

IV. Provider business mailing address

510 S CENTRAL EXPY APT. 5201
DALLAS TX
75201-5810
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-7272
  • Fax:
Mailing address:
  • Phone: 562-335-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10028391
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: