Provider Demographics
NPI:1366434078
Name:PALMER, CHRISTOPHER G (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
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 1:350 N GRANDVIEW
Mailing Address - Street 2:ATTN: LAURIE FISHNICK
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6388
Mailing Address - Country:US
Mailing Address - Phone:563-589-2612
Mailing Address - Fax:563-589-2648
Practice Address - Street 1:4005 WESTMARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2271
Practice Address - Country:US
Practice Address - Phone:563-582-6202
Practice Address - Fax:563-582-5909
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17684207X00000X, 207XX0005X
TNMD30479207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-41353OtherBC BS OF AL
51541353OtherBCBS OF ALABAMA
AL009910457Medicaid
ALD09910457Medicaid
AL009910457Medicaid
ALG79443Medicare UPIN
AL051541353Medicare PIN