MEDICARE: PALMER CLINIC ON THE KEY, LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1508984279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMER CLINIC ON THE KEY, LLC

Provider Business Mailing Address
First Line	:	240 CRANDON BLVD STE 215
Second Line	:
City	:	KEY BISCAYNE
State	:	FL
Zip	:	33149-1543
Country	:	US
Telephone Number	:	305-361-8655
Fax Number	:	305-361-9510

Provider Business Practice Location Address
First Line	:	240 CRANDON BLVD STE 215
Second Line	:
City	:	KEY BISCAYNE
State	:	FL
Zip	:	33149-1543
Country	:	US
Telephone Number	:	305-361-8655
Fax Number	:	305-361-9510

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. ROGER FARLEY PALMER
Credential	:	MD
Telephone Number	:	305-361-8655

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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