Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 14476 | AZ |
NPI | 1013019777 |
---|---|
Provider Name | Dr. John G Meernik |
First Address | Mesa, AZ 85205 |
Second Address | Mesa, AZ 85205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
252346 | (05) | AZ |
E52344 | (02) |