Provider Demographics
NPI:1437165750
Name:PALMER, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
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 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-790-1818
Mailing Address - Fax:713-790-7500
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-790-1818
Practice Address - Fax:713-790-7500
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6199207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286361501Medicaid
P00923494OtherRR MEDICARE
TX286361502Medicaid
TX286361505Medicaid
TX8FX344OtherBLUE CROSS BLUE SHIELD
TX8FE212OtherBLUE CROSS BLUE SHIELD
TX286361505Medicaid
TX8FE212OtherBLUE CROSS BLUE SHIELD
TX8FX344OtherBLUE CROSS BLUE SHIELD
TX439094ZSWDMedicare PIN
TX286361502Medicaid