Provider Demographics
NPI:1821086000
Name:PALMER, PAUL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 S UNIVERSITY AVE
Mailing Address - Street 2:STE 350
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3053
Mailing Address - Country:US
Mailing Address - Phone:920-887-0379
Mailing Address - Fax:920-887-0382
Practice Address - Street 1:705 S UNIVERSITY AVE
Practice Address - Street 2:STE 350
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3053
Practice Address - Country:US
Practice Address - Phone:920-887-0379
Practice Address - Fax:920-887-0382
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44261020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34216200Medicaid
162150003Medicare ID - Type Unspecified
WI34216200Medicaid