Provider Demographics
NPI:1538134648
Name:PALMER, SCOTT C (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
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 1:1107 9TH AVE
Mailing Address - Street 2:PO BOX 50
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1053
Mailing Address - Country:US
Mailing Address - Phone:563-659-8141
Mailing Address - Fax:563-659-2121
Practice Address - Street 1:1107 9TH AVE
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1053
Practice Address - Country:US
Practice Address - Phone:563-659-8141
Practice Address - Fax:563-659-2121
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4100271Medicaid
IA0467990001OtherMEDICARE REGION D DMERC
IA3100271Medicaid
IA3100271Medicaid
IA41042Medicare ID - Type Unspecified
IA44822Medicare ID - Type UnspecifiedLOWDEN OFFICE LOCATION