Provider Demographics
NPI:1619976073
Name:MEYER, JAY O (DPM)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:O
Last Name:MEYER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 COMMONS PKWY
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3986
Mailing Address - Country:US
Mailing Address - Phone:517-349-6855
Mailing Address - Fax:517-349-7158
Practice Address - Street 1:2158 COMMONS PKWY
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3986
Practice Address - Country:US
Practice Address - Phone:517-349-6855
Practice Address - Fax:517-349-7158
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM001350213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4814430001OtherDMERC
MI1743397Medicaid
MI4814430002OtherDMERC
MI27-00007OtherPHP
MIT33974Medicare UPIN
MI1743397Medicaid