Provider Demographics
NPI:1114067543
Name:MEYERS, GERALD M JR
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:M
Last Name:MEYERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 RAMBOW DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3548
Mailing Address - Country:US
Mailing Address - Phone:734-240-1051
Mailing Address - Fax:
Practice Address - Street 1:555 RAMBOW DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3548
Practice Address - Country:US
Practice Address - Phone:734-240-1051
Practice Address - Fax:734-240-1053
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004363237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist