MEDICARE: DR. ELIZABETH BLAIR MANNING MEYER MD

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	208100000X	Physical Medicine & Rehabilitation Physician	P4205	TX
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	P4205	TX

General Provider Information

NPI Number	:	1417133711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH BLAIR MANNING MEYER MD

Provider Business Mailing Address
First Line	:	3412 OVERTON PARK DR W
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2504
Country	:	US
Telephone Number	:	210-896-7751
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 OVERTON PARK DR W
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2504
Country	:	US
Telephone Number	:	210-896-7751
Fax Number	:

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

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	07/08/2015

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