Healthcare Provider Details

I. General information

NPI: 1407851983
Provider Name (Legal Business Name): MARK E MEIJER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 N MAIN ST
ROXBORO NC
27573-4318
US

IV. Provider business mailing address

2121 ALLENSVILLE RD
ROXBORO NC
27574-7050
US

V. Phone/Fax

Practice location:
  • Phone: 336-322-7241
  • Fax:
Mailing address:
  • Phone: 336-599-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14756
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: