Healthcare Provider Details

I. General information

NPI: 1578090502
Provider Name (Legal Business Name): ALLEN FREDRICK MEYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 REID PKWY
RICHMOND IN
47374-1157
US

IV. Provider business mailing address

1100 REID PKWY
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3144
  • Fax: 765-983-3038
Mailing address:
  • Phone: 765-983-3144
  • Fax: 765-983-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01081244A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: