Provider Demographics
NPI:1316025976
Name:MEYERS, F. BRADFORD (MD)
Entity Type:Individual
Prefix:
First Name:F.
Middle Name:BRADFORD
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 1:105 HIGHLAND TER
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:WI
Mailing Address - Zip Code:53594-2217
Mailing Address - Country:US
Mailing Address - Phone:920-478-2141
Mailing Address - Fax:920-478-3820
Practice Address - Street 1:105 HIGHLAND TER
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:WI
Practice Address - Zip Code:53594-2217
Practice Address - Country:US
Practice Address - Phone:920-478-2141
Practice Address - Fax:920-478-3820
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28978-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1316025976Medicaid
WIK400157273Medicare PIN
WIP01076485Medicare PIN
WIB85082Medicare UPIN