Provider Demographics
NPI:1295780542
Name:MEYER, EDWARD JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2333 MOWRY AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1626
Mailing Address - Country:US
Mailing Address - Phone:530-899-9112
Mailing Address - Fax:530-899-0142
Practice Address - Street 1:2333 MOWRY AVE
Practice Address - Street 2:STE 300
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1626
Practice Address - Country:US
Practice Address - Phone:530-899-9112
Practice Address - Fax:530-899-0142
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2016-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA24990207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24235Medicare UPIN
CA00A249900Medicare ID - Type UnspecifiedMEDICARE