Provider Demographics
NPI:1720039266
Name:MEYER, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
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 1:6069 S SOUTHLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5316
Mailing Address - Country:US
Mailing Address - Phone:303-928-7555
Mailing Address - Fax:303-928-7560
Practice Address - Street 1:6069 S SOUTHLANDS PKWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5316
Practice Address - Country:US
Practice Address - Phone:303-928-7555
Practice Address - Fax:303-928-7560
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97804754Medicaid
I29263Medicare UPIN
CO97804754Medicaid
CO97804754Medicaid