Healthcare Provider Details

I. General information

NPI: 1912990805
Provider Name (Legal Business Name): DONALD J MEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E BROADWAY
COLUMBIA MO
65201-5897
US

IV. Provider business mailing address

1600 E BROADWAY
COLUMBIA MO
65201-5897
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-2700
  • Fax:
Mailing address:
  • Phone: 573-815-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number105479
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: