Provider Demographics
NPI:1417135096
Name:PALMER, SHAYNE TARREL (MD)
Entity Type:Individual
Prefix:
First Name:SHAYNE
Middle Name:TARREL
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 1:8TH AVENUE AND C STREET
Mailing Address - Street 2:LDSH HOSPITAL/HOSPITALIST DEPT.
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84143-0001
Mailing Address - Country:US
Mailing Address - Phone:801-408-5482
Mailing Address - Fax:
Practice Address - Street 1:8TH AVENUE AND C STREET
Practice Address - Street 2:LDSH HOSPITAL/HOSPITALIST DEPT.
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-0001
Practice Address - Country:US
Practice Address - Phone:801-408-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6851473-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000066714Medicare PIN