MEDICARE: DR. BRADLEY RUSSELL MEYER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO-04161	IA
2	207Q00000X	Family Medicine Physician	5262	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043207939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY RUSSELL MEYER D.O.

Provider Business Mailing Address
First Line	:	2301 HIGHWAY 71 STE C
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1184
Country	:	US
Telephone Number	:	712-336-3750
Fax Number	:	712-336-3730

Provider Business Practice Location Address
First Line	:	2301 HIGHWAY 71 STE C
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1184
Country	:	US
Telephone Number	:	712-336-3750
Fax Number	:	712-336-3730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	08/28/2020

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