MEDICARE: DR. WESLEY D PALMER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G5457	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CS0674	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	760357897	OTHER	TX	WORKERS COMPENSATION

General Provider Information

NPI Number	:	1235111923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY D PALMER D.O.

Provider Business Mailing Address
First Line	:	2162 TEXAS AVE
Second Line	:
City	:	BRIDGE CITY
State	:	TX
Zip	:	77611-2838
Country	:	US
Telephone Number	:	409-735-7157
Fax Number	:	409-735-7035

Provider Business Practice Location Address
First Line	:	2162 TEXAS AVE
Second Line	:
City	:	BRIDGE CITY
State	:	TX
Zip	:	77611-2838
Country	:	US
Telephone Number	:	409-735-7157
Fax Number	:	409-735-7035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	08/18/2008

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Directions to “ DR. WESLEY D PALMER D.O.” Practice Location

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