Provider Demographics
NPI:1821064460
Name:PALMER, KEVIN V (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:V
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:SUITE 100 ATTN:CREDENTIALING
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:11373 CORTEZ BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5414
Practice Address - Country:US
Practice Address - Phone:352-596-7860
Practice Address - Fax:352-597-3657
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0070806208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31269OtherBCBS
FL379988300Medicaid
FLP00955956OtherRR MCR ATTACHED TO GRP# DR6927
FL31269XMedicare ID - Type Unspecified
FLG31442Medicare UPIN
FL379988300Medicaid