Healthcare Provider Details

I. General information

NPI: 1023243409
Provider Name (Legal Business Name): ISUZU MEYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 08/05/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42ND & EMILE
OMAHA NE
68198-1801
US

IV. Provider business mailing address

1717 6TH AVE S
BIRMINGHAM AL
35233-1801
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number32587
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number36300
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: