Healthcare Provider Details

I. General information

NPI: 1932532322
Provider Name (Legal Business Name): ETHAN ELI MEYER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 N SCOTTSDALE RD UNIT 368
SCOTTSDALE AZ
85252-3616
US

IV. Provider business mailing address

1776 N SCOTTSDALE RD UNIT 368
SCOTTSDALE AZ
85252-3616
US

V. Phone/Fax

Practice location:
  • Phone: 480-201-5264
  • Fax: 480-393-1970
Mailing address:
  • Phone: 480-201-5264
  • Fax: 480-393-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5499
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: