Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 12326A | WY |
Y | 207Q00000X | Family Doctor | 2019011044 | MO |
N | 207QA0401X | Family Doctor - Addiction Medicine | 2019011044 | MO |
NPI | 1245760495 |
---|---|
Provider Name | Dr. Jordan Adair Palmer |
First Address | Kirksville, MO 63501-4518 |
Second Address | Kirksville, MO 63501-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2017 |
Last Update Date | 09/07/2020 |