Provider Demographics
NPI:1033190681
Name:MEYERS, BRUCE PAUL (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:PAUL
Last Name:MEYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OAK DR S
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5676
Mailing Address - Country:US
Mailing Address - Phone:979-297-2477
Mailing Address - Fax:
Practice Address - Street 1:201 OAK DR S
Practice Address - Street 2:SUITE 207
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5676
Practice Address - Country:US
Practice Address - Phone:979-297-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083442601Medicaid
TX126190104Medicaid
TX126190104Medicaid
TXC19347Medicare UPIN
TX89T800Medicare ID - Type UnspecifiedPHYSICIAN MEDICARE #