Provider Demographics
NPI:1922076611
Name:MEYER, MARY E (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8267 ELMBROOK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4030
Mailing Address - Country:US
Mailing Address - Phone:214-237-1651
Mailing Address - Fax:214-237-1743
Practice Address - Street 1:8267 ELMBROOK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4030
Practice Address - Country:US
Practice Address - Phone:214-237-1665
Practice Address - Fax:214-631-6724
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50625207ZP0105X
TXJ4353207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C506250Medicaid
CA00C506250Medicaid
CA00C506250Medicare PIN