Provider Demographics
NPI:1992730790
Name:PALMER, ROBERT HARDING JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HARDING
Last Name:PALMER
Suffix:JR
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:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0052
Mailing Address - Country:US
Mailing Address - Phone:360-344-3700
Mailing Address - Fax:360-344-3707
Practice Address - Street 1:1136 WATER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6728
Practice Address - Country:US
Practice Address - Phone:360-344-3700
Practice Address - Fax:360-344-3707
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABP0643014207VG0400X
WAMD00023938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1044429Medicaid
CAA42086OtherMEDICAL LICENSE
WAMD00023938OtherMEDICAL LICENSE
GA028849OtherMEDICAL LICENSE
WAMD00023938OtherMEDICAL LICENSE
WA8809143Medicare ID - Type Unspecified