Provider Demographics
NPI:1134228828
Name:PALMER, HIRAM SCHUBERT (MD)
Entity type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:SCHUBERT
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SCHUBERT
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 331100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-0002
Mailing Address - Country:US
Mailing Address - Phone:323-224-2040
Mailing Address - Fax:323-224-2061
Practice Address - Street 1:1701 E CESAR E CHAVEZ AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2464
Practice Address - Country:US
Practice Address - Phone:323-224-2040
Practice Address - Fax:323-224-2061
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45372207RI0011X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G453720Medicaid
CA060047064OtherRAILROAD MEDICARE
CAGR0100070Medicaid
CAZZZ66380ZOtherBLUE SHIELD PROVIDER NUMB
CAW14113Medicare ID - Type UnspecifiedPROVIDER ID
CAHW14113Medicare ID - Type UnspecifiedPROVIDER ID
CAWG45372HMedicare PIN
CA060047064OtherRAILROAD MEDICARE
CAGR0100070Medicaid
CAA50003Medicare UPIN
CA00G453720Medicaid