Provider Demographics
NPI:1235131962
Name:MEESE, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:MEESE
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 1:550 MEMORIAL CIR
Mailing Address - Street 2:SUITE H
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5059
Mailing Address - Country:US
Mailing Address - Phone:386-672-0017
Mailing Address - Fax:386-676-0506
Practice Address - Street 1:550 MEMORIAL CIR
Practice Address - Street 2:SUITE H
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5059
Practice Address - Country:US
Practice Address - Phone:386-672-0017
Practice Address - Fax:386-676-0506
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048579208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043283100Medicaid
FL280000474OtherRAILROAD MEDICARE
FLD57734Medicare UPIN
FL043283100Medicaid