Provider Demographics
NPI:1386811784
Name:JAMIE F MEYERS, DDS, MD, PA
Entity type:Organization
Organization Name:JAMIE F MEYERS, DDS, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:903-723-5111
Mailing Address - Street 1:1721 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-6921
Mailing Address - Country:US
Mailing Address - Phone:903-723-5111
Mailing Address - Fax:903-723-0328
Practice Address - Street 1:1721 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6921
Practice Address - Country:US
Practice Address - Phone:903-723-5111
Practice Address - Fax:903-723-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L19HOtherBLUE CROSS/BLUE SHIELD
TX034546401Medicaid
TX859955OtherUNITED CONCORDIA
TXG60231OtherCHIPS
TX859955OtherUNITED CONCORDIA