Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G8628 | TX |
NPI | 1114982915 |
---|---|
Provider Name | Dan Marshall Meyer |
First Address | Dallas, TX 75237-4408 |
Second Address | Dallas, TX 75208-4176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8FW428 | BLUE CROSS (01) | TX |
E92900 | (02) |