Provider Demographics
NPI:1386084101
Name:PALMER, JAIME RENEE (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:RENEE
Last Name:PALMER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:RENEE
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2074 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-3372
Mailing Address - Country:US
Mailing Address - Phone:541-885-2011
Mailing Address - Fax:208-375-2217
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036153895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR170061Medicaid
OR38-1845Medicare PIN
ORR101150Medicare PIN