MEDICARE: DR. RICHARD EARLE PALMER JR. M.D.

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	2084P0800X	Psychiatry Physician	F4350	TX

General Provider Information

NPI Number	:	1811998420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD EARLE PALMER JR. M.D.

Provider Business Mailing Address
First Line	:	12345 JONES RD
Second Line	:	STE. 101
City	:	HOUSTON
State	:	TX
Zip	:	77070-4855
Country	:	US
Telephone Number	:	281-469-2181
Fax Number	:	281-894-8611

Provider Business Practice Location Address
First Line	:	12345 JONES RD
Second Line	:	STE. 101
City	:	HOUSTON
State	:	TX
Zip	:	77070-4855
Country	:	US
Telephone Number	:	281-469-2181
Fax Number	:	281-894-8611

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

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	12/17/2007

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