Provider Demographics
NPI:1427099100
Name:MEYER, CARISSA S (MD)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:S
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2875
Mailing Address - Country:US
Mailing Address - Phone:972-373-0303
Mailing Address - Fax:972-373-8074
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:BUILDING 2 SUITE 150
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2420
Practice Address - Country:US
Practice Address - Phone:972-373-0303
Practice Address - Fax:972-373-8074
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9256208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165674601Medicaid
TX165674603Medicaid
TX165674603Medicaid