Provider Demographics
NPI:1689665283
Name:MEYER, JOSEPH D (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
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 1:523 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2421
Mailing Address - Country:US
Mailing Address - Phone:218-238-2010
Mailing Address - Fax:218-283-2011
Practice Address - Street 1:523 3RD AVE
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2421
Practice Address - Country:US
Practice Address - Phone:218-238-2010
Practice Address - Fax:218-283-2011
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37003207R00000X
MN43731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07N96MEOtherBCBS MINNESOTA
0408988OtherMEDICA
MN882217400Medicaid