Provider Demographics
NPI:1134137680
Name:MEYER, SUZANNE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LOUISE
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 1:830 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1209 WOODROW AVE
Practice Address - Street 2:SUITE B10
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1288
Practice Address - Country:US
Practice Address - Phone:209-558-5312
Practice Address - Fax:209-558-5310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G493651Medicare ID - Type UnspecifiedMCR INDIVIDUAL
A51343Medicare UPIN