Provider Demographics
NPI:1912187246
Name:PALMER, BRIAN WESLEY (RPSGT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:WESLEY
Last Name:PALMER
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-3249
Mailing Address - Country:US
Mailing Address - Phone:513-746-5104
Mailing Address - Fax:
Practice Address - Street 1:641 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-3249
Practice Address - Country:US
Practice Address - Phone:513-746-5104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4364247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other