Provider Demographics
NPI:1386630283
Name:MEYER, J PAUL (MD)
Entity Type:Individual
Prefix:
First Name:J PAUL
Middle Name:
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:PO BOX 5465
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5465
Mailing Address - Country:US
Mailing Address - Phone:308-398-1147
Mailing Address - Fax:
Practice Address - Street 1:603 N DIERS AVE STE 2
Practice Address - Street 2:SUITE 2
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4987
Practice Address - Country:US
Practice Address - Phone:308-398-1147
Practice Address - Fax:308-398-1149
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21104207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE277605Medicare PIN
E73104Medicare UPIN
NEP00344986Medicare PIN