Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 31379 DO | MO |
NPI | 1003098872 |
---|---|
Provider Name | Dr. Allen Palmer |
First Address | Bridgeton, MO 63044-0681 |
Second Address | Clayton, MO 63105-2679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2007 |
Last Update Date | 29/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D41562 | (02) | MO |