Provider Demographics
NPI:1548604598
Name:MEYER, DOUGLAS L
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0 PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4808
Mailing Address - Country:US
Mailing Address - Phone:314-223-0553
Mailing Address - Fax:636-395-7235
Practice Address - Street 1:0 PAUL AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4808
Practice Address - Country:US
Practice Address - Phone:314-223-0553
Practice Address - Fax:636-395-7235
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities