Provider Demographics
NPI:1821280892
Name:PALMER, RICHARD MICHAEL (MD, CEDIR)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD, CEDIR
Other - Prefix:
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Mailing Address - Street 1:3886 E PACKARD DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4826
Mailing Address - Country:US
Mailing Address - Phone:520-316-0800
Mailing Address - Fax:480-664-3563
Practice Address - Street 1:13985 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3625
Practice Address - Country:US
Practice Address - Phone:520-316-0800
Practice Address - Fax:480-664-3563
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ29903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH69804Medicare UPIN