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General NPI Number Information
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NPI Number | 1225145196
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Entity Type | Individual
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Provider Name | DANIEL W PALMER JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 120 NE GLEN OAK AVE SUITE 408
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City | PEORIA
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State | IL
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Zip | 61603-4314
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Country | US
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Telephone | 309-672-3158
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Fax | 309-672-3114
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Provider Business Mailing Address
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Address Line | 2205 VIRGINIA AVE
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City | CONNERSVILLE
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State | IN
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Zip | 47331-4314
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Country | US
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Telephone | 765-827-8064
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Fax | 765-825-6999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036085061
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License Number State | IL
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