Provider Demographics
NPI:1669550075
Name:MEYER, WAYNE WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:WALTER
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 1:1851 CHESTNUT
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2275
Mailing Address - Country:US
Mailing Address - Phone:314-923-8532
Mailing Address - Fax:314-923-8542
Practice Address - Street 1:1831 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2225
Practice Address - Country:US
Practice Address - Phone:314-923-8532
Practice Address - Fax:314-923-8542
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5391305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization