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General NPI Number Information
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NPI Number | 1558387886
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Entity Type | Individual
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Provider Name | GARY LEE MEYER
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4561 DICKEY DR
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City | LA MESA
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State | CA
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Zip | 91941-5735
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Country | US
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Telephone | 619-328-3025
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Fax | 619-312-0528
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Provider Business Mailing Address
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Address Line | 12695 CAMINO MIRA DEL MAR 116
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City | SAN DIEGO
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State | CA
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Zip | 92130-2582
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Country | US
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Telephone | 858-437-4445
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Fax | 858-350-6746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA 17549
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License Number State | CA
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