Provider Demographics
NPI:1922072396
Name:PALERMO, JOSEPH THOMAS JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:PALERMO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10564 - 5TH AVE NE
Mailing Address - Street 2:#201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125
Mailing Address - Country:US
Mailing Address - Phone:206-367-1222
Mailing Address - Fax:206-364-2664
Practice Address - Street 1:10564 - 5TH AVE NE
Practice Address - Street 2:#201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125
Practice Address - Country:US
Practice Address - Phone:206-367-1222
Practice Address - Fax:206-364-2664
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP0836207RG0300X
WAOP00000836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0205759OtherLIWA
WA1476001Medicaid
WA3150PAOtherBSWA
WAE20232Medicare UPIN
WA3150PAOtherBSWA
E20232Medicare UPIN
WA1476001Medicaid
WAGAB22099Medicare PIN