Healthcare Provider Details

I. General information

NPI: 1659362507
Provider Name (Legal Business Name): TAMMY L MEYERHOFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 NORTHWAY COURT CENTRACARE CLINIC HEARTLAND
ST CLOUD MN
56303
US

IV. Provider business mailing address

1520 NORTHWAY COURT CENTRACARE CLINIC HEARTLAND
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-1775
  • Fax: 320-240-3131
Mailing address:
  • Phone: 320-251-1775
  • Fax: 320-240-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43732
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: