Provider Demographics
NPI:1659362507
Name:MEYERHOFER, TAMMY L (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:MEYERHOFER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1520 NORTHWAY COURT
Mailing Address - Street 2:CENTRACARE CLINIC HEARTLAND
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-251-1775
Mailing Address - Fax:320-240-3131
Practice Address - Street 1:1520 NORTHWAY COURT
Practice Address - Street 2:CENTRACARE CLINIC HEARTLAND
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-251-1775
Practice Address - Fax:320-240-3131
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-11-29
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Provider Licenses
StateLicense IDTaxonomies
MN43732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0113564OtherMEDICA HEALTH PLANS
HP38793OtherHEALTH PARTNERS
2116672OtherFIRST HEALTH PLAN
610970500OtherMEDICAL ASSISTANCE
1034423OtherPREFERRED ONE
140306OtherU CARE
374J9NEOtherBLUE CROSS BLUE SHIELD
1834156OtherARAZ GRP/AMERICA'S PPO
HP38793OtherHEALTH PARTNERS
H43923Medicare UPIN