Provider Demographics
NPI:1700855236
Name:PALMER, PENNY M (MD)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:M
Last Name:PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E INDIANA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2313
Mailing Address - Country:US
Mailing Address - Phone:509-241-4207
Mailing Address - Fax:509-444-3256
Practice Address - Street 1:123 E INDIANA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2313
Practice Address - Country:US
Practice Address - Phone:509-241-4207
Practice Address - Fax:509-444-3256
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037224207P00000X
AZ364582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7148406Medicaid
WA7922404Medicaid