Provider Demographics
NPI:1902828288
Name:MEYER, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 CORPORATE DR
Mailing Address - Street 2:COLORADO SPRINGS
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1941
Mailing Address - Country:US
Mailing Address - Phone:719-598-7562
Mailing Address - Fax:719-598-2775
Practice Address - Street 1:5901 CORPORATE DR
Practice Address - Street 2:COLORADO SPRINGS
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1941
Practice Address - Country:US
Practice Address - Phone:719-598-7562
Practice Address - Fax:719-598-2775
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35250207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84281278Medicaid
CO01352509Medicaid
COC437208Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
CO01352509Medicaid