Provider Demographics
NPI:1750474078
Name:PALMER, BRUCE LEE (M D)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LEE
Last Name:PALMER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1631 11TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4320
Mailing Address - Country:US
Mailing Address - Phone:940-264-3222
Mailing Address - Fax:940-264-3225
Practice Address - Street 1:1631 11TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4320
Practice Address - Country:US
Practice Address - Phone:940-264-3222
Practice Address - Fax:940-264-3225
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8961207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S6801OtherBLUE CROSS BLUE SHIELD
8F0893Medicare ID - Type Unspecified
I39480Medicare UPIN