Provider Demographics
NPI:1013019777
Name:MEERNIK, JOHN G (M D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:MEERNIK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6247 E. MAIN STREET
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:480-981-9151
Mailing Address - Fax:480-981-0527
Practice Address - Street 1:6247 E. MAIN STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-981-9151
Practice Address - Fax:480-981-0527
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14476207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ252346Medicaid
65758Medicare ID - Type Unspecified
AZ252346Medicaid