Provider Demographics
NPI:1013921667
Name:MEYER, NEAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:R
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 1:311 N KEENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6623
Mailing Address - Country:US
Mailing Address - Phone:573-442-1788
Mailing Address - Fax:573-442-1789
Practice Address - Street 1:311 N KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6623
Practice Address - Country:US
Practice Address - Phone:573-442-1788
Practice Address - Fax:573-442-1789
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001574932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205054505Medicaid
MO16010365Medicare PIN
G96396Medicare UPIN
MO205054505Medicaid
MO300114381Medicare PIN
MOCH0689Medicare PIN
MO001013832Medicare PIN