Provider Demographics
NPI:1992782999
Name:PALMER, GREGORY L (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:PALMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 STEEPLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-1807
Mailing Address - Country:US
Mailing Address - Phone:803-648-1213
Mailing Address - Fax:
Practice Address - Street 1:205 STEEPLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-1807
Practice Address - Country:US
Practice Address - Phone:803-648-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC124193400000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No193400000XGroupSingle Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC7033Medicare PIN
SCU39233Medicare UPIN