Provider Demographics
NPI:1639127186
Name:PALMER, WILLIAM FREDRICK (PT,MS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:FREDRICK
Last Name:PALMER
Suffix:
Gender:M
Credentials:PT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 RECOVERY RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3267
Mailing Address - Country:US
Mailing Address - Phone:573-888-9190
Mailing Address - Fax:573-888-9404
Practice Address - Street 1:306 RECOVERY RD
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3267
Practice Address - Country:US
Practice Address - Phone:573-888-9190
Practice Address - Fax:573-888-9404
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0582174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO410490OtherGROUP # FOR HEALTHLINK
MO1873945OtherGROUP # FOR FIRST HEALTH
MO120210OtherGROUP # FOR BC/BS