Basic Information
Provider Information | |||||||||
NPI: | 1609397942 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PALMER | ||||||||
FirstName: | AUBREY | ||||||||
MiddleName: | LEKEENAN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PALMER | ||||||||
OtherFirstName: | AUBREY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 301 UNIVERSITY BLVD | ||||||||
Address2: |   | ||||||||
City: | GALVESTON | ||||||||
State: | TX | ||||||||
PostalCode: | 775551385 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4097722166 | ||||||||
FaxNumber: | 4097722663 | ||||||||
Practice Location | |||||||||
Address1: | 4864 JACKSON ST | ||||||||
Address2: |   | ||||||||
City: | MONROE | ||||||||
State: | LA | ||||||||
PostalCode: | 712026400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3183307000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/27/2017 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/08/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 323442 | LA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207Q00000X | BP10060861 | TX | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 323442 | LA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.