Provider Demographics
NPI:1588730345
Name:PALMER, BONITA A (MD)
Entity type:Individual
Prefix:DR
First Name:BONITA
Middle Name:A
Last Name:PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BONITA
Other - Middle Name:ANN
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3661 20TH ST # A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2301
Mailing Address - Country:US
Mailing Address - Phone:415-550-7900
Mailing Address - Fax:415-550-7900
Practice Address - Street 1:3661 20TH ST # A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2301
Practice Address - Country:US
Practice Address - Phone:415-550-7900
Practice Address - Fax:415-550-7900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG035357207Q00000X
CAG035457207QH0002X, 2084P0800X, 2084H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G354570Medicaid
CA94-3124827OtherEMPLOYER IDENTIFICATION #
CA2018023Medicaid
CA00G354570Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAA46363Medicare UPIN