Provider Demographics
NPI:1427095694
Name:PALMER, DOUGLAS R (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
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 1:3524 E MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1626
Mailing Address - Country:US
Mailing Address - Phone:608-756-7100
Mailing Address - Fax:
Practice Address - Street 1:3524 E MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-1626
Practice Address - Country:US
Practice Address - Phone:608-756-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27483-020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00801177CD3624OtherRR MEDICARE
WIPALMEDOUOtherMERCYCARE INSURANCE
WI0900029OtherPHYSICIANS PLUS INSURANCE
WI39171561401OtherUNITY
WI30748700Medicaid
WI980OtherDEAN HEALTH INSURANCE
WI39171561401OtherUNITY
WI000127048Medicare PIN
WIP00801177CD3624OtherRR MEDICARE
WI980OtherDEAN HEALTH INSURANCE
WI000027048Medicare PIN
WI0900029OtherPHYSICIANS PLUS INSURANCE