Healthcare Provider Details

I. General information

NPI: 1588044630
Provider Name (Legal Business Name): PAUL MEINERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISION RD
GREAT FALLS MT
59404
US

IV. Provider business mailing address

1600 DIVISION RD
GREAT FALLS MT
59404-1921
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-2171
  • Fax:
Mailing address:
  • Phone: 269-337-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5315070818
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: