Provider Demographics
NPI:1346386950
Name:MEYERS, JAMIE F (DDS MD PA)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:F
Last Name:MEYERS
Suffix:
Gender:F
Credentials:DDS MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 S SYCAMORE
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:903-723-5111
Mailing Address - Fax:903-723-0328
Practice Address - Street 1:1721 S SYCAMORE
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801
Practice Address - Country:US
Practice Address - Phone:903-723-5111
Practice Address - Fax:903-723-0328
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3856204E00000X
TX154371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48955Medicare UPIN
TX00L19HMedicare ID - Type Unspecified