Healthcare Provider Details

I. General information

NPI: 1821093881
Provider Name (Legal Business Name): JEROLD A MEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20265 EMERY RD
NORTH RANDALL OH
44128-4122
US

IV. Provider business mailing address

55435 TR 170
FRESNO OH
43824
US

V. Phone/Fax

Practice location:
  • Phone: 440-523-9966
  • Fax: 216-584-2895
Mailing address:
  • Phone: 740-322-0332
  • Fax: 740-622-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35042571
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: