Provider Demographics
NPI:1588633838
Name:PALMER, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:345 SHERMAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2401
Mailing Address - Country:US
Mailing Address - Phone:651-251-5500
Mailing Address - Fax:651-251-5555
Practice Address - Street 1:345 SHERMAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2401
Practice Address - Country:US
Practice Address - Phone:651-251-5500
Practice Address - Fax:651-251-5555
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN363902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN833S5PAOtherBLUE CROSS BLUE SHIELD MN
MN119421OtherUCARE MN
WI34489100Medicaid
MN01010114OtherPREFERREDONE
MNHP17918OtherHEALTHPARTNERS
MN542019900Medicaid
MN2400134OtherMEDICA
MN341296OtherAMERICA'S PPO
MNHP17918OtherHEALTHPARTNERS
MNP00117141Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI34489100Medicaid