Provider Demographics
NPI:1114192564
Name:LINDA J PALMER DPM PA
Entity Type:Organization
Organization Name:LINDA J PALMER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-736-3383
Mailing Address - Street 1:9850 61ST WAY S
Mailing Address - Street 2:A
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2882
Mailing Address - Country:US
Mailing Address - Phone:561-736-3383
Mailing Address - Fax:561-732-4662
Practice Address - Street 1:9850 61ST WAY S
Practice Address - Street 2:A
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2882
Practice Address - Country:US
Practice Address - Phone:561-736-3383
Practice Address - Fax:561-732-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2868213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAM440Medicare PIN