Provider Demographics
NPI:1417205618
Name:MEYER, JOHN GARY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GARY
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5715 48TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3677
Mailing Address - Country:US
Mailing Address - Phone:360-281-5774
Mailing Address - Fax:253-565-0658
Practice Address - Street 1:5715 48TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3677
Practice Address - Country:US
Practice Address - Phone:360-281-5774
Practice Address - Fax:253-565-0658
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA00017394207QA0505X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine