Provider Demographics
NPI:1124050265
Name:MESCHLER, JUSTIN P (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:P
Last Name:MESCHLER
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:PO BOX 17389
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-0389
Mailing Address - Country:US
Mailing Address - Phone:425-407-1000
Mailing Address - Fax:425-407-1112
Practice Address - Street 1:1100 BALSAM AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304
Practice Address - Country:US
Practice Address - Phone:303-415-7000
Practice Address - Fax:425-407-1112
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058074207L00000X, 207LP2900X
CODR0055201207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA808556222AMedicaid
CO1124050265Medicaid