Provider Demographics
NPI:1922054477
Name:PALMER, JULIE ROBIN (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ROBIN
Last Name:PALMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-9413
Mailing Address - Country:US
Mailing Address - Phone:662-844-9376
Mailing Address - Fax:662-744-4326
Practice Address - Street 1:3411 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-9413
Practice Address - Country:US
Practice Address - Phone:662-844-9376
Practice Address - Fax:662-744-4326
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02406721Medicaid
I32734Medicare UPIN