Provider Demographics
NPI:1902986284
Name:MEYER, STEVEN R (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CHARLTON ROAD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD PARK
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T8H 1R5
Mailing Address - Country:CA
Mailing Address - Phone:780-464-1023
Mailing Address - Fax:
Practice Address - Street 1:47 CHARLTON ROAD
Practice Address - Street 2:
Practice Address - City:SHERWOOD PARK
Practice Address - State:ALBERTA
Practice Address - Zip Code:T8H 1R5
Practice Address - Country:CA
Practice Address - Phone:780-464-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102779208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN826498000Medicaid
MN780000113Medicare ID - Type Unspecified
MNI 63321Medicare UPIN