Provider Demographics
NPI:1609190115
Name:MEIER, MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:
Last Name:MEIER
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 1:525 N SWITZER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4845
Mailing Address - Country:US
Mailing Address - Phone:928-773-2280
Mailing Address - Fax:928-773-2280
Practice Address - Street 1:525 N SWITZER CANYON DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4845
Practice Address - Country:US
Practice Address - Phone:928-773-2280
Practice Address - Fax:928-773-2280
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50681208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ32428Medicaid
CO50210OtherLICENSE
AZ50681OtherMEDICAL LICENSE