Healthcare Provider Details

I. General information

NPI: 1164716874
Provider Name (Legal Business Name): JONATHAN DAVID MEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE SUITE 4D
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

1200 CHILDRENS AVE SUITE 4D
OKLAHOMA CITY OK
73104-4637
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number30628
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: