Provider Demographics
NPI:1578619912
Name:PALMER, THOMAS RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RYAN
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2551 GREENWOOD RD
Mailing Address - Street 2:STE 350
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3989
Mailing Address - Country:US
Mailing Address - Phone:318-212-8710
Mailing Address - Fax:318-212-8699
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 380
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-631-9121
Practice Address - Fax:318-631-9126
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2020-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.14251R207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1408778Medicaid
LA4K5307561Medicare PIN