Provider Demographics
NPI:1811991797
Name:MEYER, JEFFREY P (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
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 1:4730 N HABANA AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7148
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-864-4436
Practice Address - Street 1:4600 SE 29TH ST
Practice Address - Street 2:SUITE 750
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3406
Practice Address - Country:US
Practice Address - Phone:405-733-5900
Practice Address - Fax:405-733-5905
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23469174400000X
NE22920193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes193400000XGroupSingle Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH29204Medicare UPIN