MEDICARE: WILLIAM HENRY MEYERS III SFIDC

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1750733853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM HENRY MEYERS III SFIDC

Provider Business Mailing Address
First Line	:	UNIT 100150 BOX 1
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96643-5000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6427 REFLECTION DR APT 102
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-3188
Country	:	US
Telephone Number	:	727-543-6662
Fax Number	:

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

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	04/07/2026

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