Provider Demographics
NPI:1134105687
Name:MEYER, KATHARINA (MD)
Entity Type:Individual
Prefix:
First Name:KATHARINA
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
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:PO BOX 30149
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1149
Mailing Address - Country:US
Mailing Address - Phone:850-474-8121
Mailing Address - Fax:850-474-8096
Practice Address - Street 1:1715 N BUNNER ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2229
Practice Address - Country:US
Practice Address - Phone:251-943-2300
Practice Address - Fax:251-943-2416
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83517207RN0300X
ALMD.21746208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13241OtherBLUE CROSS BLUE SHIELD
AL591-82120OtherBLUE CROSS BLUE SHIELD
7492350OtherAETNA
AL009935447Medicaid
FL264297200Medicaid
FL13241YMedicare PIN
AL591-82120OtherBLUE CROSS BLUE SHIELD
AL009935447Medicaid