Provider Demographics
NPI:1982647467
Name:PALMER, THOMAS R (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:PALMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3864
Mailing Address - Country:US
Mailing Address - Phone:503-255-8100
Mailing Address - Fax:503-255-2728
Practice Address - Street 1:6108 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3864
Practice Address - Country:US
Practice Address - Phone:503-255-8100
Practice Address - Fax:503-255-2728
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00202213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137490OtherMEDICARE GROUP #
OR170446Medicaid
OR170446Medicaid
107844Medicare ID - Type Unspecified