Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4301041830 | MI |
NPI | 1306910815 |
---|---|
Provider Name | Thomas R. Palmer |
First Address | Detroit, MI 48202 |
Second Address | Detroit, MI 48202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A76083 | (02) | |
TP041830 | CHAMPUS-CHAMPUS (01) | |
TP041830 | COMMERCIAL-COMMERCIAL NUMBER (01) |