Provider Demographics
NPI:1982704516
Name:PALMER, JONATHON D (MD)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:D
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 1:4301 W MARKHAM ST
Mailing Address - Street 2:UAMS #783
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-603-1436
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:UAMS #783
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8000
Practice Address - Fax:501-603-1436
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3664207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00351560OtherRAILROAD MEDICARE
ARE3664OtherTRICARE
AR149498001Medicaid
ARP00037818OtherRAILROAD MCARE THRU WCMC
AR149498001Medicaid
ARP00351560OtherRAILROAD MEDICARE
ARP00037818OtherRAILROAD MCARE THRU WCMC