Provider Demographics
NPI:1922715382
Name:PALMER, DEVON T
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:T
Last Name:PALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 CONSTITUTION AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5808
Mailing Address - Country:US
Mailing Address - Phone:505-363-6461
Mailing Address - Fax:
Practice Address - Street 1:6801 JEFFERSON ST NE STE 301
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-7390
Practice Address - Country:US
Practice Address - Phone:505-705-1701
Practice Address - Fax:505-212-1253
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist