Provider Demographics
NPI:1841296209
Name:PALMER, HAROLD DEREK (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:DEREK
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1245 NW 4TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1680
Mailing Address - Country:US
Mailing Address - Phone:541-323-4545
Mailing Address - Fax:541-323-4546
Practice Address - Street 1:1245 NW 4TH ST
Practice Address - Street 2:STE 201
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1680
Practice Address - Country:US
Practice Address - Phone:541-323-4545
Practice Address - Fax:541-323-4546
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-11-28
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Provider Licenses
StateLicense IDTaxonomies
ORMD19294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR72376Medicaid
OR72376Medicaid
ORG08451Medicare UPIN