Provider Demographics
NPI:1003098872
Name:PALMER, ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-0681
Mailing Address - Country:US
Mailing Address - Phone:314-800-3777
Mailing Address - Fax:314-569-3162
Practice Address - Street 1:7730 DAVIS DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-2679
Practice Address - Country:US
Practice Address - Phone:314-800-3777
Practice Address - Fax:314-569-3162
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31379 DO207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD41562Medicare UPIN
MO512600001Medicare PIN