Provider Demographics
NPI:1407964141
Name:BILLMEIER, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BILLMEIER
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 1:1717 N CLYDE MORRIS BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5532
Mailing Address - Country:US
Mailing Address - Phone:386-777-3721
Mailing Address - Fax:877-325-2429
Practice Address - Street 1:1717 N CLYDE MORRIS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5532
Practice Address - Country:US
Practice Address - Phone:386-777-3721
Practice Address - Fax:877-325-2429
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2422845OtherAETNA
FL45360OtherMEDICARE GROUP#
FL59-3667262OtherTAX ID#
FLMQ343OtherMEDICARE
FL080164322OtherRAILROAD MEDICARE
FL255172100Medicaid
FL255172100Medicaid