Healthcare Provider Details

I. General information

NPI: 1609879105
Provider Name (Legal Business Name): STEPHEN MEFFERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 MENDOCINO AVE STE 380
SANTA ROSA CA
95403-3612
US

IV. Provider business mailing address

3536 MENDOCINO AVE STE 380
SANTA ROSA CA
95403-3612
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-5353
  • Fax: 707-523-7733
Mailing address:
  • Phone: 707-575-5353
  • Fax: 707-523-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA51000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: