Provider Demographics
NPI:1518928878
Name:MEYERS, MARK A (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:MEYERS
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 1:30012 N CAVE CREEK RD
Mailing Address - Street 2:STE 104
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5833
Mailing Address - Country:US
Mailing Address - Phone:480-714-5614
Mailing Address - Fax:
Practice Address - Street 1:30012 N CAVE CREEK RD
Practice Address - Street 2:STE 104
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5833
Practice Address - Country:US
Practice Address - Phone:480-714-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12450207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ229965Medicaid
AZ229965Medicaid
AZD12825Medicare UPIN
AZZ131947Medicare UPIN
AZZ183735Medicare UPIN