Provider Demographics
NPI:1952414096
Name:PALMER, BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4066 DUNNICA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-3510
Mailing Address - Country:US
Mailing Address - Phone:636-224-1700
Mailing Address - Fax:314-535-5917
Practice Address - Street 1:2315 DOUGHERTY FERRY RD STE 107
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3383
Practice Address - Country:US
Practice Address - Phone:314-966-7570
Practice Address - Fax:314-966-7788
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3G71207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOB18594Medicare UPIN