Healthcare Provider Details

I. General information

NPI: 1871656579
Provider Name (Legal Business Name): WALTER TERRENCE MEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER MSC 3529 BOX 300001
LAS CRUCES NM
88003-8001
US

IV. Provider business mailing address

PO BOX 30001 MSC 3529 NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CEN
LAS CRUCES NM
88003-8001
US

V. Phone/Fax

Practice location:
  • Phone: 505-646-6510
  • Fax: 505-646-6428
Mailing address:
  • Phone: 505-646-6510
  • Fax: 505-646-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74205
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: