Provider Demographics
NPI:1093792079
Name:PALMER, EDWARD EATON JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:EATON
Last Name:PALMER
Suffix:JR
Gender:M
Credentials:MD
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 235003
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5003
Mailing Address - Country:US
Mailing Address - Phone:334-274-9000
Mailing Address - Fax:334-274-0857
Practice Address - Street 1:4294 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3604
Practice Address - Country:US
Practice Address - Phone:334-274-9000
Practice Address - Fax:334-274-0857
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5971207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000080878Medicaid
51032887OtherBLUE CROSS
51055278OtherBLUE CROSS
717863OtherFIRST HEALTH
0910185OtherUNITED HEALTHCARE
5910114OtherAETNA
550179OtherPRIME HEALTH
AL000055278Medicaid
200027780OtherRR MEDICARE
6453OtherNCC/TYNET
H430Medicare PIN
550179OtherPRIME HEALTH
51055278OtherBLUE CROSS
000055278Medicare PIN
5910114OtherAETNA
000080878Medicare PIN
717863OtherFIRST HEALTH
AL000055278Medicaid
D564Medicare PIN
H431Medicare PIN