Provider Demographics
NPI:1285671206
Name:MEYER, ALEXANDER BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:BRIAN
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 1:900 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1610
Mailing Address - Country:US
Mailing Address - Phone:805-766-0031
Mailing Address - Fax:
Practice Address - Street 1:243 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2804
Practice Address - Country:US
Practice Address - Phone:805-766-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A705430Medicaid
CAGR0024030OtherMEDI-CAL
CAZZZ13094ZOtherBLUE SHIELD
CAZZZ13094ZOtherBLUE SHIELD
CAGR0024030OtherMEDI-CAL
CAW10034Medicare Oscar/Certification
CAWA70543JMedicare PIN