Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 7589 | AZ |
Y | 225400000X | Rehabilitation Practitioner | 4276 | AZ |
NPI | 1619932431 |
---|---|
Provider Name | Dr. Shawn Michael Meyer |
First Address | Scottsdale, AZ 85251-3635 |
Second Address | Scottsdale, AZ 85251-3635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 05/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202901918 | FEDERAL TAX ID (01) | AZ |
AZ0945690 | BLUE CROSS BLUE SHIELD (01) | AZ |
U80518 | (02) | AZ |