Provider Demographics
NPI:1447235254
Name:MEYER, BENJAMIN H (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:H
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 1:260 HOSPITAL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4568
Mailing Address - Country:US
Mailing Address - Phone:707-463-7425
Mailing Address - Fax:707-462-1111
Practice Address - Street 1:115 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4591
Practice Address - Country:US
Practice Address - Phone:707-463-2400
Practice Address - Fax:707-463-3520
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88684207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447235254Medicaid
CA00G886840OtherBLUE SHIELD
MD341941000Medicaid
CAP00853330OtherRAILROAD MEDICARE
CADE464YMedicare PIN
CADE464ZMedicare PIN
CA00G886840OtherBLUE SHIELD
MDD72286Medicare UPIN
MDH640R983Medicare PIN