Provider Demographics
NPI:1679575161
Name:MEYERS, JERRY R (MD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:R
Last Name:MEYERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14791 THORNBIRD MANOR PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2496
Mailing Address - Country:US
Mailing Address - Phone:636-532-6585
Mailing Address - Fax:636-532-8024
Practice Address - Street 1:4201 S CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6438
Practice Address - Country:US
Practice Address - Phone:636-929-4390
Practice Address - Fax:636-928-1242
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO30764208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10805Medicare UPIN