Provider Demographics
NPI:1437145679
Name:MEYER, JERRY FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:FRANCIS
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 1:1140 VARNUM ST NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2151
Mailing Address - Country:US
Mailing Address - Phone:202-832-3100
Mailing Address - Fax:202-832-9475
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:SUITE 102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-832-3100
Practice Address - Fax:202-832-9475
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD5280174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC192670P72Medicare PIN
DC192670Medicare PIN