Healthcare Provider Details

I. General information

NPI: 1578536884
Provider Name (Legal Business Name): MEL R MEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 BISHOP RANDALL DR
LANDER WY
82520-3939
US

IV. Provider business mailing address

PO BOX 1276
SALEM UT
84653-1276
US

V. Phone/Fax

Practice location:
  • Phone: 307-265-4010
  • Fax:
Mailing address:
  • Phone: 801-423-3306
  • Fax: 801-423-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5543A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: