Healthcare Provider Details

I. General information

NPI: 1588856413
Provider Name (Legal Business Name): SARAH ELISABETH MEYERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N COLUMBIA RD STOP 9037
GRAND FORKS ND
58203-2817
US

IV. Provider business mailing address

501 N COLUMBIA RD PO BOX 9037
GRAND FORKS ND
58203-2817
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-1200
  • Fax: 701-777-3108
Mailing address:
  • Phone: 701-777-2037
  • Fax: 701-777-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20452
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number54524
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number54524
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: