Provider Demographics
NPI:1629038633
Name:MEYER, BRUCE P (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:P
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 1:453 WATERBURY CT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5309
Mailing Address - Country:US
Mailing Address - Phone:614-471-0652
Mailing Address - Fax:614-509-6001
Practice Address - Street 1:453 WATERBURY CT
Practice Address - Street 2:SUITE 220
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5309
Practice Address - Country:US
Practice Address - Phone:614-471-0652
Practice Address - Fax:614-509-6001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-02-7482-M2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH150947Medicaid
OHC02194Medicare UPIN