MEDICARE: DR. BRIAN E MEYER MD

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	207P00000X	Emergency Medicine Physician	E-2709	AR

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	:	1386697480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN E MEYER MD

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:	SUITE 201
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 BRADEN ST
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3721
Country	:	US
Telephone Number	:	501-221-3519
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/24/2010

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