Provider Demographics
NPI:1245232305
Name:MEYERS, PATRICK GLEN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:GLEN
Last Name:MEYERS
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:1120 N 103RD PLZ STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1119
Practice Address - Country:US
Practice Address - Phone:402-354-0220
Practice Address - Fax:402-354-0225
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18167207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026480109Medicaid
IA1245232305Medicaid
IA3954032Medicaid
IA17222Medicare ID - Type Unspecified
E43817Medicare UPIN