Provider Demographics
NPI:1982992517
Name:MEYERS, JORDAN DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DAVID
Last Name:MEYERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E GUDE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1496
Mailing Address - Country:US
Mailing Address - Phone:919-850-9111
Mailing Address - Fax:919-850-2499
Practice Address - Street 1:1418 E. MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4812
Practice Address - Country:US
Practice Address - Phone:919-850-9111
Practice Address - Fax:919-850-2499
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-17
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00381213ES0103X
NC604213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty