Provider Demographics
NPI:1649731779
Name:PALMER, COLTON LEE (MD)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:LEE
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1834
Mailing Address - Country:US
Mailing Address - Phone:315-464-5240
Mailing Address - Fax:315-464-3751
Practice Address - Street 1:2373 G RD STE 160
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1003
Practice Address - Country:US
Practice Address - Phone:970-644-3250
Practice Address - Fax:970-644-3915
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0072286208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program