Healthcare Provider Details

I. General information

NPI: 1336569029
Provider Name (Legal Business Name): BENJAMIN WILLIAM MEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E THIRD STREET
DULUTH MN
55805-1951
US

IV. Provider business mailing address

400 EAST THIRD STREET MCL2CRED
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63651
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: