=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073720173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KYLE L. PALMER, M.D., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 01/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3875 EAST OVERLAND ROAD
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-884-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3875 EAST OVERLAND ROAD
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-884-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KYLE L PALMER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 208-884-8300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | M5987
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------