Provider Demographics
NPI:1235111923
Name:PALMER, WESLEY D (DO)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:D
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 1:2162 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-2838
Mailing Address - Country:US
Mailing Address - Phone:409-735-7157
Mailing Address - Fax:409-735-7035
Practice Address - Street 1:2162 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-2838
Practice Address - Country:US
Practice Address - Phone:409-735-7157
Practice Address - Fax:409-735-7035
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123091406Medicaid
TXCS0674OtherRAILROAD MEDICARE
TX760357897OtherWORKERS COMPENSATION
TX123091406Medicaid