Healthcare Provider Details

I. General information

NPI: 1386630283
Provider Name (Legal Business Name): J PAUL MEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N DIERS AVE STE 2 SUITE 2
GRAND ISLAND NE
68803-4987
US

IV. Provider business mailing address

PO BOX 5465
GRAND ISLAND NE
68802-5465
US

V. Phone/Fax

Practice location:
  • Phone: 308-398-1147
  • Fax: 308-398-1149
Mailing address:
  • Phone: 308-398-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number21104
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: