Provider Demographics
NPI:1629204383
Name:MEYER, MATTHEW ALAN (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
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 1:2008 CHELSEA CT
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3487
Mailing Address - Country:US
Mailing Address - Phone:812-528-0482
Mailing Address - Fax:
Practice Address - Street 1:225 S PINE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2365
Practice Address - Country:US
Practice Address - Phone:812-523-7893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072984A2084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program