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General NPI Number Information
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NPI Number | 1154512614
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Entity Type | Organization
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Legal Business Name | LEWIS MEYERSON, MD
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 104 SARAH ANN BLVD
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City | TROY
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State | MO
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Zip | 63379-2038
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Country | US
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Telephone | 636-528-5281
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Fax | 636-462-2637
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Provider Business Mailing Address
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Address Line | 104 SARAH ANN BLVD
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City | TROY
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State | MO
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Zip | 63379-2038
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Country | US
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Telephone | 636-528-5281
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Fax | 636-462-2637
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEWIS AARON MEYERSON
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Credential | MD
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Telephone | 636-528-5281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2002021114
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 106340
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License Number State | MO
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