Provider Demographics
NPI:1255303210
Name:PALMER, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:PALMER
Suffix:
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1819 CAREW ST
Practice Address - Street 2:ATTENTION: POLLY BALOSKI
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4705
Practice Address - Country:US
Practice Address - Phone:260-481-4810
Practice Address - Fax:260-481-4883
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043018A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200907600Medicaid
OH2912665Medicaid
INP00825407OtherR.R. MEDICARE
IN000000641094OtherANTHEM
OH2912665Medicaid
IN000000641094OtherANTHEM
193580ZMedicare PIN
IN193590DDMedicare PIN