Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D6100 | OR |
NPI | 1003899188 |
---|---|
Provider Name | John Edward Palmer |
First Address | Newport, OR 97365 |
Second Address | Newport, OR 97365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 08/07/2007 |