Provider Demographics
NPI:1164492963
Name:PALMER, ROBERT C (NP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:PALMER
Suffix:
Gender:M
Credentials:NP
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 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:6801 EMMETT F LOWRY EXPY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2500
Practice Address - Country:US
Practice Address - Phone:409-938-5000
Practice Address - Fax:409-938-5001
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX573147363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX500026141OtherRAILROAD MEDICARE PROV #
TX147691305Medicaid
TX147691303Medicaid
TX8N2841OtherBC/BS PROVIDER NUMBER
TX1164492963OtherTRICRE SOUTH
TX147691304Medicaid
TX1164492963OtherTRICRE SOUTH
TXP41414Medicare UPIN
TX147691305Medicaid
TX147691303Medicaid
TX8L21006Medicare PIN