Provider Demographics
NPI:1831250141
Name:MEISEL, HARRY JOSEPH (PAC)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:JOSEPH
Last Name:MEISEL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 CALUMET WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3358
Mailing Address - Country:US
Mailing Address - Phone:541-741-1226
Mailing Address - Fax:541-741-0673
Practice Address - Street 1:21 HAYDEN BRIDGE WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1305
Practice Address - Country:US
Practice Address - Phone:541-741-1226
Practice Address - Fax:541-741-0673
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00320363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR144844Medicare PIN