Provider Demographics
NPI:1801893862
Name:PALMER, JENNIFER LILLIAN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LILLIAN
Last Name:PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:WESTPOORT MEDICAL PLAZA
Mailing Address - Street 2:2605 WASHINGTON STREET
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219
Mailing Address - Country:US
Mailing Address - Phone:641-620-9119
Mailing Address - Fax:641-613-1305
Practice Address - Street 1:WESTPOORT MEDICAL PLAZA
Practice Address - Street 2:2605 WASHINGTON STREET
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219
Practice Address - Country:US
Practice Address - Phone:641-620-9119
Practice Address - Fax:641-613-1305
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA27747207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0262469Medicaid
E60091Medicare UPIN
IAI5663Medicare ID - Type Unspecified