MEDICARE: RICHARD ANDREW MAYER M.D.

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	207RI0200X	Infectious Disease Physician	A79246	CA

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	:	1689773640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ANDREW MAYER M.D.

Provider Business Mailing Address
First Line	:	4231 BALBOA AVE # 218
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5504
Country	:	US
Telephone Number	:
Fax Number	:	619-573-4413

Provider Business Practice Location Address
First Line	:	4231 BALBOA AVE # 218
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5504
Country	:	US
Telephone Number	:	619-573-4413
Fax Number	:	619-573-4413

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	12/06/2017

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