Healthcare Provider Details

I. General information

NPI: 1417214958
Provider Name (Legal Business Name): JAMES FREEMAN PALMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 N 300 W
PROVO UT
84604-6124
US

IV. Provider business mailing address

1157 N 300 W
PROVO UT
84604-6124
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7525
  • Fax:
Mailing address:
  • Phone: 801-357-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number10333270-1204
License Number StateUT

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: