MEDICARE: MR. RICHARD IRVING PALMER

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	372600000X	Adult Companion
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1417279043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD IRVING PALMER

Provider Business Mailing Address
First Line	:	2651 UNIVERSITY BLVD N
Second Line	:	APT G 09
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-8313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2651 UNIVERSITY BLVD N
Second Line	:	APT G 09
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-8313
Country	:	US
Telephone Number	:	904-424-5755
Fax Number	:

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

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	02/23/2010

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Directions to “ MR. RICHARD IRVING PALMER ” Practice Location

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