=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023109923
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRED H MEYER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 02/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 S SUNSET ST
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80521-2147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-224-2156
-----------------------------------------------------
Fax | 970-482-6936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 S SUNSET STREET
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80521-2147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-224-2156
-----------------------------------------------------
Fax | 970-482-6936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 25100
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 3714A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 21258
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------