Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | M9232 | ID |
NPI | 1033105259 |
---|---|
Provider Name | George William Palmer |
First Address | Boise, ID 83706-1394 |
Second Address | Boise, ID 83706-1394 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 21/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215061734 | (05) | ID |
H53419 | (02) |