Healthcare Provider Details

I. General information

NPI: 1326023391
Provider Name (Legal Business Name): BRIAN W MEEKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRIAN W MEEKER D.O.

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 11/17/2020
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N 9TH AVE
VINTON IA
52349-2254
US

IV. Provider business mailing address

504 N 9TH AVE
VINTON IA
52349-2254
US

V. Phone/Fax

Practice location:
  • Phone: 319-472-6300
  • Fax: 319-472-6300
Mailing address:
  • Phone: 319-472-6300
  • Fax: 319-472-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-02109
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: