Provider Demographics
NPI:1578574372
Name:MEIER, MATTHEW
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MEIER
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 1:51 CATAMARAN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2904
Mailing Address - Country:US
Mailing Address - Phone:636-561-2418
Mailing Address - Fax:
Practice Address - Street 1:1002 PERUQUE CROSSING CT
Practice Address - Street 2:SUITE 102
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2362
Practice Address - Country:US
Practice Address - Phone:636-294-5757
Practice Address - Fax:636-294-5742
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODOR9J58207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00061101OtherRAILROAD MEDICARE
MOP00061101OtherRAILROAD MEDICARE
MO001013911Medicare PIN