MEDICARE: FRED H MEYER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	25100	CO
2	207RR0500X	Rheumatology Physician	3714A	WY
3	207RR0500X	Rheumatology Physician	21258	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023109923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED H MEYER M.D.

Provider Business Mailing Address
First Line	:	219 S SUNSET STREET
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2147
Country	:	US
Telephone Number	:	970-224-2156
Fax Number	:	970-482-6936

Provider Business Practice Location Address
First Line	:	219 S SUNSET ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2147
Country	:	US
Telephone Number	:	970-224-2156
Fax Number	:	970-482-6936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	02/07/2008

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