Provider Demographics
NPI:1164955308
Name:PALMER, BENJAMIN (DPM)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 DUNLOP LN STE 209
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5193
Mailing Address - Country:US
Mailing Address - Phone:855-897-6812
Mailing Address - Fax:
Practice Address - Street 1:647 DUNLOP LN STE 209
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5193
Practice Address - Country:US
Practice Address - Phone:855-897-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN935213ES0103X
390200000X
KY283247213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363366652OtherPRESENCE ST. JOSEPH HOSPITAL CHICAGO