Healthcare Provider Details

I. General information

NPI: 1457702227
Provider Name (Legal Business Name): BRANDON MEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SHEYENNE ST
WEST FARGO ND
58078-2637
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-4445
  • Fax: 701-234-4385
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301109862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: