Provider Demographics
NPI:1972595981
Name:MEYER, PHILIP F (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:MEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MAC LANE
Mailing Address - Street 2:AVERA MEDICAL GROUP PIERRE
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-945-5267
Mailing Address - Fax:605-945-5295
Practice Address - Street 1:100 MAC LANE
Practice Address - Street 2:AVERA MEDICAL GROUP PIERRE
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501
Practice Address - Country:US
Practice Address - Phone:605-945-5267
Practice Address - Fax:605-945-5295
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4230207R00000X
SDSD4230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6003542Medicaid
SD6003540Medicaid
SD6003540Medicaid
SD6003542Medicaid
SDG49360Medicare UPIN