Healthcare Provider Details

I. General information

NPI: 1689715849
Provider Name (Legal Business Name): JEFFREY LEE MEYER, D.O.M. D.O.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 N CHAMISA DR SUITE 3
SANTA FE NM
87508-9463
US

IV. Provider business mailing address

7 BALSA RD
SANTA FE NM
87508-8319
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-2766
  • Fax:
Mailing address:
  • Phone: 505-690-7758
  • Fax: 505-466-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number486
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: