Provider Demographics
NPI:1487623567
Name:PALMER, PATRICK M (MD)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:M
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 681572
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78268-1572
Mailing Address - Country:US
Mailing Address - Phone:210-670-9030
Mailing Address - Fax:210-675-4072
Practice Address - Street 1:8111 PRINCESS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2253
Practice Address - Country:US
Practice Address - Phone:210-670-9030
Practice Address - Fax:210-675-4072
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1098207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089726603Medicaid
TX089726601Medicaid
TXC20149Medicare UPIN
TXTXB129196Medicare PIN
TX089726603Medicaid