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NPI Code Detail

MEDICARE: ERIC J MEYER PA-C

MEDICARE: ERIC J MEYER PA-C
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
1363AM0700XMedical Physician Assistant10135MN

Other Identifiers

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

General Provider Information

NPI Number : 1649209966
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC J MEYER PA-C
Provider Business Mailing Address
First Line : PO BOX 14909
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-0909
Country : US
Telephone Number : 612-871-1145
Fax Number : 651-641-0556
Provider Business Practice Location Address
First Line : 3001 BROADWAY ST NE STE 500
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-2197
Country : US
Telephone Number : 612-871-1145
Fax Number : 612-870-5491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 11/19/2019

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