Provider Demographics
NPI:1154400745
Name:MEYER, ROGER H (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:H
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:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NE
Mailing Address - Zip Code:68456-0095
Mailing Address - Country:US
Mailing Address - Phone:402-534-2851
Mailing Address - Fax:402-534-2005
Practice Address - Street 1:800 3RD ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NE
Practice Address - Zip Code:68456-6162
Practice Address - Country:US
Practice Address - Phone:402-534-2851
Practice Address - Fax:402-534-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEE36126Medicare UPIN