Provider Demographics
NPI:1629071725
Name:MEYER, JOAN MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARIE
Last Name:MEYER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1147 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3219
Mailing Address - Country:US
Mailing Address - Phone:760-738-1583
Mailing Address - Fax:760-738-1169
Practice Address - Street 1:1147 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3219
Practice Address - Country:US
Practice Address - Phone:760-738-1583
Practice Address - Fax:760-738-1169
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2846213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28460Medicaid
CA000E28460Medicaid
CA000E2486Medicare ID - Type Unspecified