Provider Demographics
NPI:1013950575
Name:MEYERS, GERALD L (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:MEYERS
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 1:3017 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2049
Mailing Address - Country:US
Mailing Address - Phone:510-841-0689
Mailing Address - Fax:510-841-8119
Practice Address - Street 1:2450 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2067
Practice Address - Country:US
Practice Address - Phone:510-204-1894
Practice Address - Fax:510-841-0435
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19754207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G197540Medicaid
A40743Medicare UPIN
00G197541Medicare ID - Type Unspecified