Provider Demographics
NPI:1235338088
Name:BAKER-PALMER, REBECCA M (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:BAKER-PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 UNION CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9357
Mailing Address - Country:US
Mailing Address - Phone:260-482-4440
Mailing Address - Fax:
Practice Address - Street 1:1260 E STATE ROAD 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-9492
Practice Address - Country:US
Practice Address - Phone:260-248-9000
Practice Address - Fax:260-458-3205
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066377A207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200943130Medicaid
INM400048081Medicare PIN