Healthcare Provider Details

I. General information

NPI: 1295120608
Provider Name (Legal Business Name): MARK JEFFERY MEUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 N PALMER RD
BETHESDA MD
20889-8273
US

IV. Provider business mailing address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DR
JBSA FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 805-865-6648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6698320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: