Provider Demographics
NPI:1679584213
Name:PALMER, JERRY M (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:M
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:661 HELEN KELLER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:TUSCALOUSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404
Mailing Address - Country:US
Mailing Address - Phone:205-554-0866
Mailing Address - Fax:205-554-0279
Practice Address - Street 1:661 HELEN KELLER BLVD
Practice Address - Street 2:STE A
Practice Address - City:TUSCALOUSA
Practice Address - State:AL
Practice Address - Zip Code:35404
Practice Address - Country:US
Practice Address - Phone:205-554-0866
Practice Address - Fax:205-554-0279
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL78072084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0099182Y0Medicaid
AL51007490Medicare ID - Type Unspecified