Provider Demographics
NPI:1023109923
Name:MEYER, FRED H (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:H
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 1:219 S SUNSET STREET
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2147
Mailing Address - Country:US
Mailing Address - Phone:970-224-2156
Mailing Address - Fax:970-482-6936
Practice Address - Street 1:219 S SUNSET ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2147
Practice Address - Country:US
Practice Address - Phone:970-224-2156
Practice Address - Fax:970-482-6936
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25100207RR0500X
WY3714A207RR0500X
NE21258207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01251008Medicaid
C63001Medicare PIN
D24574Medicare UPIN