Provider Demographics
NPI:1235596107
Name:MEYER, KATIE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:MARIE
Last Name:MEYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 MERCY AVENUE SUITE 400
Mailing Address - Street 2:DHMG - MERCED
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-564-3700
Mailing Address - Fax:209-564-3725
Practice Address - Street 1:315 MERCY AVENUE SUITE 400
Practice Address - Street 2:DHMG - MERCED
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-564-3700
Practice Address - Fax:209-564-3725
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-24
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3516208000000X
CA20A14636208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics