Provider Demographics
NPI:1154502540
Name:MEYER, KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MEYER
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 1:517 CATALPA ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7426
Mailing Address - Country:US
Mailing Address - Phone:318-966-8343
Mailing Address - Fax:318-966-8343
Practice Address - Street 1:517 CATALPA ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7426
Practice Address - Country:US
Practice Address - Phone:318-966-8343
Practice Address - Fax:318-966-8343
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73407208600000X
LAMD.09302R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41948OtherBCBS
LA1993158Medicaid
FL252221100Medicaid
FL252221100Medicaid
LA5U542CX79Medicare PIN
FL252221100Medicaid