Provider Demographics
NPI:1609878339
Name:MEYER, JOSEPH LOREN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LOREN
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 1:1880 ROUND ROCK AVE
Mailing Address - Street 2:STE # 100
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4084
Mailing Address - Country:US
Mailing Address - Phone:512-248-4007
Mailing Address - Fax:512-248-4007
Practice Address - Street 1:1880 ROUND ROCK AVE
Practice Address - Street 2:STE# 100
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4084
Practice Address - Country:US
Practice Address - Phone:512-248-4007
Practice Address - Fax:512-248-4007
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6595207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042324601Medicaid
TX8F9815Medicare PIN
TXG69756Medicare UPIN
TX042324601Medicaid