Provider Demographics
NPI:1447278544
Name:PALMER, JEFFREY S (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24755 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5682
Mailing Address - Country:US
Mailing Address - Phone:216-292-2111
Mailing Address - Fax:216-292-9979
Practice Address - Street 1:24755 CHAGRIN BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5682
Practice Address - Country:US
Practice Address - Phone:216-292-2111
Practice Address - Fax:216-292-9979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-080080208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2289732Medicaid
OHH24620Medicare UPIN
OH2289732Medicaid