MEDICARE: F. BRADFORD MEYERS 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	207Q00000X	Family Medicine Physician	28978-020	WI

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	:	1316025976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	F. BRADFORD MEYERS M.D.

Provider Business Mailing Address
First Line	:	105 HIGHLAND TER
Second Line	:
City	:	WATERLOO
State	:	WI
Zip	:	53594-2217
Country	:	US
Telephone Number	:	920-478-2141
Fax Number	:	920-478-3820

Provider Business Practice Location Address
First Line	:	105 HIGHLAND TER
Second Line	:
City	:	WATERLOO
State	:	WI
Zip	:	53594-2217
Country	:	US
Telephone Number	:	920-478-2141
Fax Number	:	920-478-3820

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/14/2021

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