Provider Demographics
NPI:1306806179
Name:MEYERS, SAMUEL GRANT II (PA-C)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GRANT
Last Name:MEYERS
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:GRANT
Other - Last Name:MEYERS
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3787 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6148
Mailing Address - Country:US
Mailing Address - Phone:910-332-3800
Mailing Address - Fax:910-332-3833
Practice Address - Street 1:3787 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6148
Practice Address - Country:US
Practice Address - Phone:910-332-3800
Practice Address - Fax:910-332-3833
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104018363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101420Medicaid
NC1306806179OtherCHAMPUS
NC1306806179OtherCHAMPUS