Healthcare Provider Details

I. General information

NPI: 1174900823
Provider Name (Legal Business Name): GRANT MEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 11/20/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 AERO DR STE 130
SAN DIEGO CA
92123-1767
US

IV. Provider business mailing address

8765 AERO DR STE 130
SAN DIEGO CA
92123-1767
US

V. Phone/Fax

Practice location:
  • Phone: 858-541-0181
  • Fax: 858-715-3809
Mailing address:
  • Phone: 858-541-0181
  • Fax: 858-715-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA148779
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA148779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: